Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: Beneficial or detrimental?

2018 ◽  
Vol 63 (1) ◽  
pp. 137-137
Author(s):  
Brian Burns ◽  
Cliff Reid ◽  
Karel Habig ◽  
Matt Miller ◽  
Geoff Healy
Keyword(s):  
Trauma Patients ◽  
Hospital Emergency ◽  
Emergency Anaesthesia

Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental?

2018 ◽  
Vol 62 (4) ◽  
pp. 504-514 ◽  
Author(s):  
K. Crewdson ◽  
M. Rehn ◽  
K. Brohi ◽  
D. J. Lockey
Keyword(s):  
Trauma Patients ◽  
Hospital Emergency ◽  
Emergency Anaesthesia

scholarly journals 217 The end-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after pre-hospital emergency anaesthesia: a retrospective observational study

2020 ◽  
Vol 37 (12) ◽  
pp. 847.1-847
Author(s):  
James Price ◽  
Daniel Sandbach ◽  
Ari Ercole ◽  
Alastair Wilson ◽  
Ed Barnard
Keyword(s):  
Carbon Dioxide ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Thoracic Injury ◽  
Secondary Brain Injury ◽  
Hospital Emergency ◽  
Hospital Arrival ◽  
Arterial Blood ◽  
End Tidal ◽  
Emergency Anaesthesia

Aims/Objectives/BackgroundIn the United Kingdom (UK), 20% of patients with severe traumatic brain injury (TBI) receive pre-hospital emergency anaesthesia (PHEA). Current guidance recommends an end-tidal carbon dioxide (ETCO2) of 4.0–4.5kPa to achieve a low-normal arterial partial pressure of CO2 (PaCO2), and reduce secondary brain injury. This recommendation assumes a 0.5kPa ETCO2-PaCO2 gradient. However, the gradient in the acute phase of TBI is unknown. Our primary aim was to report the ETCO2-PaCO2 gradient of TBI patients at hospital arrival.Methods/DesignA retrospective cohort study of adult patients with serious TBI, who received a PHEA by a pre-hospital critical care team in the East of England between 1st April 2015 to 31st December 2017. Linear regression was performed to test for correlation and reported as R-squared (R2). A Bland-Altman plot was used to test for paired ETCO2 and PaCO2 agreement and reported with 95% confidence intervals (95%CI). ETCO2-PaCO2 gradient data were compared with a two-tailed, unpaired, t-test.Results/Conclusions107 patients were eligible for inclusion. Sixty-seven patients did not receive a PaCO2 sample within 30 minutes of hospital arrival and were therefore excluded. Forty patients had complete data and were included in the final analysis; per protocol.The mean ETCO2-PaCO2 gradient was 1.7 (±1.0) kPa, with only moderate correlation of ETCO2 and PaCO2 at hospital arrival (R2=0.23, p=0.002). The Bland-Altman bias was 1.7 (95%CI 1.4–2.0) kPa with upper and lower limits of agreement of 3.6 (95%CI 3.0–4.1) kPa and -0.2 (95%CI -0.8–0.3) kPa respectively. There was no significant gradient correlation in patients with a co-existing serious thoracic injury (R2=0.13, p=0.10), and this cohort had a larger ETCO2-PaCO2 gradient, 2.0 (±1.1) kPa, p=0.01. Patients who underwent pre-hospital arterial blood sampling had an arrival PaCO2 of 4.7 (±0.2) kPa.Lower ETCO2 targets than previously recommended may be safe and appropriate. The use of pre-hospital PaCO2 measurement is advocated.

scholarly journals Pre-hospital use of intravenous in-line fluid warmers to reduce morbidity and mortality for major trauma patients: A review of the current literature.

2015 ◽  
Vol 12 (2) ◽  
Author(s):  
Nicholas Collins ◽  
Stuart Daly ◽  
Patricia Johnson ◽  
Gavin Smith
Keyword(s):  
Patient Outcomes ◽  
Major Trauma ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Hospital Emergency ◽  
Mortality And Morbidity ◽  
Poor Patient ◽  
Patient Morbidity ◽  
Lethal Triad

IntroductionIn-line fluid warmers are an established treatment for delivering warmed intravenous (IV) fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care.MethodsA review of the electronic literature, including the Medline and Ebscohost databases was conducted using the terms “intravenous fluid warmers” “hypothermia”, “ trauma”, “ fluid”, “coagulopathy”, “ acidosis”, “hypothermia and trauma patients”, “accidental hypothermia”, “lethal triad” and “trauma care”. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded.ResultsThe review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’- a condition that results in poor patient outcomes and high mortality rates.ConclusionThis review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.

Unrecognized HIV-1 Infection in Inner-City Hospital Emergency Department Patients

1996 ◽  
Vol 17 (3) ◽  
pp. 174-177
Author(s):  
Tippavan Nagachinta ◽  
Claudia R. Gold ◽  
Fenny Cheng ◽  
Peter N.R. Heseltine ◽  
Peter R. Kerndt
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Trauma Patients ◽  
City Hospital ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Uninsured Patients ◽  
Emergency Department Patients ◽  
Immunodeficiency Syndrome ◽  
Hiv 1

AbstractTo determine the prevalence of unrecognized human immunodeficiency virus (HIV)-1 infections in patients presenting to an inner-city hospital emergency department, medical records were reviewed from 1,945 patients diagnosed with diseases not related to HIV or acquired immunodeficiency syndrome. The overall seroprevalence was 2.1% (40):1.8% (11) in nontrauma versus 3.0% (29) in trauma patients. The highest prevalence was found in black, male, uninsured patients.

scholarly journals Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
P. Leitch ◽  
A. L. Hudson ◽  
J. E. Griggs ◽  
R. Stolmeijer ◽  
R. M. Lyon ◽  
...  
Keyword(s):  
Major Trauma ◽  
Hospital Setting ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Trauma Patients ◽  
Blood Gas ◽  
Hospital Emergency ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Abstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.

scholarly journals Pre-hospital emergency medicine and the trauma intensive care unit

2018 ◽  
Vol 20 (3) ◽  
pp. 242-247
Author(s):  
Emily Frostick ◽  
Christopher Johnson
Keyword(s):  
Intensive Care Unit ◽  
Emergency Medicine ◽  
Intensive Care ◽  
Trauma Care ◽  
Major Trauma ◽  
Trauma Patients ◽  
Care Providers ◽  
Hospital Emergency ◽  
Trauma Networks ◽  
National Training

The system of trauma care has been revolutionised over the last decade with the introduction of major trauma networks across the United Kingdom and the development of subspecialist national training in pre-hospital emergency medicine. Pre-hospital care providers feed trauma patients into trauma units or major trauma centres depending upon the severity of their injuries and their stability for a potentially longer primary transfer to access specialist major trauma services. Trauma services are continually adapting and improving with the introduction of more advanced techniques into the pre-hospital arena are on the horizon, enabling trauma patients to receive more specialised treatment from medical professionals earlier after injury; this article will discuss some of the recent developments within pre-hospital emergency medicine, in-hospital trauma care and on into the intensive care unit, and how this has led to improved outcomes.

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