scholarly journals Pre‐hospital emergency anaesthesia in trauma patients treated by anaesthesiologist and nurse anaesthetist staffed critical care teams

2021 ◽  
Author(s):  
Bjarni Árnason ◽  
Daniel Hertzberg ◽  
Daniel Kornhall ◽  
Mattias Günther ◽  
Mikael Gellerfors
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Hospital Emergency ◽  
Nurse Anaesthetist ◽  
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

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

scholarly journals Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jing-Chun Song ◽  
◽  
Li-Kun Yang ◽  
Wei Zhao ◽  
Feng Zhu ◽  
...  
Keyword(s):  
Critical Care ◽  
Tissue Injury ◽  
Massive Hemorrhage ◽  
Expert Consensus ◽  
Chinese Society ◽  
Trauma Patients ◽  
Pathophysiological Mechanism ◽  
Trauma Induced Coagulopathy ◽  
Education Association ◽  
Post Traumatic

AbstractTrauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2–85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People’s Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.

Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

2020 ◽  
pp. 000313482097298
Author(s):  
Samuel J. Zolin ◽  
Jasmin K. Bhangu ◽  
Brian T. Young ◽  
Sarah E. Posillico ◽  
Husayn A. Ladhani ◽  
...  
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Family Meeting ◽  
Comfort Care ◽  
Code Status ◽  
Family Meetings ◽  
Dying Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Poor Outcomes

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.

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.

Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S62-S66
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Homer Tien ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Session ◽  
Ultrasound Image ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Didactic Training ◽  
Training Course ◽  
Fast Exam

AbstractBackgroundThe Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session.MethodsThe interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05.ResultsFourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively.ConclusionsThis study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.

scholarly journals Nurses’ perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services

2021 ◽  
Vol 62 ◽  
pp. 102966
Author(s):  
María Teresa González-Gil ◽  
Cristina González-Blázquez ◽  
Ana Isabel Parro-Moreno ◽  
Azucena Pedraz-Marcos ◽  
Ana Palmar-Santos ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Services ◽  
Care Delivery ◽  
Hospital Emergency ◽  
Critical Care Units ◽  
Nurses Perceptions
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