European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Influence of prehospital treatment on the outcome of patients with severe blunt traumatic brain injury: a single-centre study.
AIM, PATIENTS, AND METHODS: To compare retrospectively the outcomes of patients with severe traumatic brain injury (Injury Severity Score, ISS total >or=15; the Abbreviated ISS-head, aISS(head) >or=9) admitted to our Intensive Care Unit by helicopter (helicopter emergency medical service, HEMS group = 89) with those transported by ambulance (GROUND group = 105) from January 2002 to December 2007. ⋯ In our experience, aggressive early treatment of patients with severe traumatic brain injury was associated with a better outcome likely because of the prevention of secondary brain injury and a shorter interval elapsing from the trauma to definitive care despite more time spent on the scene by the intervening team.
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We evaluated the relationship of lactate measured in a preclinical setting with outcome. Simultaneously, we evaluated the feasibility of implementing blood lactate measurement in a prehospital setting as part of a quality improvement project. ⋯ Implementation of lactate measurement in prehospital setting is feasible, and potentially clinical relevant. Lactate measured in a preclinical setting is related to outcome. Subsequent studies should evaluate whether treatment of shock patients based on prehospital lactate measurement will improve outcome.
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We aim to determine whether the duration of paediatric training and previous real life intraosseous (IO) insertion experience influence a trainee paediatrician's decision on emergency vascular access choices. ⋯ Nothing helps more than previous real life IO needle insertion experience to reduce trainee paediatricians' reluctance in using IO access in an emergency, but this experience was only found more frequently among the more experienced trainees. IO access-specific workshops may provide useful supplemental training to traditional resuscitation courses, and may reduce trainees' reluctance in its use.
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Fractures of the pubic ramus are commonly seen in the emergency room, but they are thought to be minor injuries. Occasionally, these fractures might be associated with massive haemorrhage. Here we report a case of bilateral obturator artery damage due to minimal displaced pubic ramus fracture.