Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To evaluate the frequency of use, placement site, success and misplacement rates, and need for intervention for tube thoracostomies (TTs), and the complications with endotracheal intubation associated with TT in the prehospital setting. ⋯ Tube thoracostomy positioning mostly depends on the discretion of the physician on scene. The Monaldi and Bülau positions do not differ in misplacement or complication rates.
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Comparative Study
Abnormal end-tidal carbon dioxide levels on emergency department arrival in adult and pediatric intubated patients.
The utility of prehospital intubation is controversial, as uncontrolled studies in trauma patients suggest adverse outcomes with prehospital intubation, perhaps secondary to inappropriate ventilation once intubation is accomplished. ⋯ Nearly half of all patients transported by prehospital providers had abnormal ETCO(2) measurements on initial ED presentation, suggesting an area for potential improvement. Trauma patients with abnormal initial ETCO(2) levels were more likely to die.
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Comparative Study
Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting.
The objective of this study was to determine the effects of low-fractional concentration of inspired oxygen (FiO(2)) continuous positive airway pressure (CPAP) in prehospital noninvasive ventilation (NIV). With increasing concerns about the detrimental effects of hyperoxia, we sought to determine whether CPAP using a low FiO(2) (28%-30%) was effective in the prehospital setting. ⋯ CPAP using a low FiO(2) (28%-30%) was highly effective in the treatment of commonly encountered prehospital respiratory emergencies.
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To describe the experience of a U.S. emergency medical services (EMS) agency utilizing a dispatch algorithm to identify low-acuity patients and determine whether secondary telephone triage by a nurse was associated with subsequent hospital admission among those patients. ⋯ This study identified a method for classifying patients during the dispatch period as low-acuity while attempting to ensure that those individuals received the medical care that they needed.
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Multicenter Study Comparative Study
Epidemiology of out-of hospital pediatric cardiac arrest due to trauma.
To determine the epidemiology and survival of pediatric out-of-hospital cardiac arrest (OHCA) secondary to trauma. ⋯ The overall survival rate for OHCA in children after trauma was low, but some trauma mechanisms are associated with better survival rates than others. Most OHCA in children is preventable, and education and prevention strategies should focus on those overrepresented populations and high-risk mechanisms to improve mortality.