scholarly journals Physician staffing pattern and outcomes of trauma patients in a department of emergency and critical care

2007 ◽  
Vol 14 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Jun Uehara ◽  
Shigehiko Uchino ◽  
Takashi Matou ◽  
Hiroto Kasai ◽  
Shin Takenouchi
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Staffing Pattern ◽  
Physician Staffing

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.

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.

Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

2017 ◽  
Vol 32 (5) ◽  
pp. 536-540 ◽  
Author(s):  
Domhnall O’Dochartaigh ◽  
Matthew Douma ◽  
Chris Alexiu ◽  
Shell Ryan ◽  
Mark MacKenzie
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Medical Patients ◽  
Shock Index ◽  
Patient Acuity ◽  
Emergency Medical

AbstractIntroductionPrehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.ProblemWhich patients may benefit from PHUS has not been clearly identified.MethodsA multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”ResultsBoth models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).Conclusions:In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.O’DochartaighD, DoumaM, AlexiuC, RyanS, MacKenzieM. Utilization criteria for prehospital ultrasound in a Canadian critical care Helicopter Emergency Medical Service: determining who might benefit. Prehosp Disaster Med. 2017;32(5):536–540.

Managing the Monitors: An Analysis of Alarm Silencing Activities during an Anesthetic Procedure

2000 ◽  
Vol 44 (26) ◽  
pp. 250-253 ◽  
Author(s):  
Yan Xiao ◽  
Colin F. Mackenzie ◽  
F. Jacob Seagull ◽  
Mahmood Jaberi
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
Patient Monitoring ◽  
Life Support ◽  
Attention Allocation ◽  
Trauma Patients ◽  
Care Providers ◽  
The Real ◽  
Patient Status ◽  
Monitoring Devices

Patient monitoring devices are designed to assist users in obtaining information on the patient and life-support equipment status. Most of the these devices have built-in visual and auditory alarms, which are to help the user to manage attention allocation. In this presentation we describe an analysis of the interaction between care providers and the monitoring devices during an anesthetic procedure (airway management) for trauma patients in the real environment. The videotapes of 47 cases were analyzed by coding the activities in silencing auditory alarms. In majority of the cases (87%) alarms could be heard yet only a small portion of the cases (6%) contained patient status events that signified by the alarm conditions. Care providers were frequently forced to interrupt clinical tasks to silence alarms. The differences in silencing frequency and rapidity among different monitoring devices suggest that alarms could be designed to be less intrusive and more tolerable, thus making the monitors easier to manage in critical care settings

scholarly journals Factors affecting mortality of critical care trauma patients

2013 ◽  
Vol 13 (3) ◽  
Author(s):  
AF Hefny ◽  
K Idris ◽  
HO Eid ◽  
FM Abu-Zidan
Keyword(s):  
Critical Care ◽  
Trauma Patients ◽  
Factors Affecting
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