Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Airway management remains a fundamental component of optimal care of the severely injured patient, with endotracheal intubation representing the definitive strategy for airway control. However, multiple studies document an association between out-of-hospital intubation and increased mortality for severe traumatic brain injury. ⋯ Patients in whom intubation is attempted have higher adjusted mortality. However, sites with a higher rate of attempted intubation have lower adjusted mortality across the entire cohort of trauma patients with GCS scores ≤ 8. Coma Scale score.
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The American Heart Association encourages trained and untrained bystanders to perform, at a minimum, chest compressions on anyone who suddenly collapses. It is possible that people who are not in cardiac arrest may receive bystander cardiopulmonary resuscitation (CPR), from which the potential for injury is unknown. ⋯ Bystanders provide CPR for patients who are not in cardiac arrest at a relatively low frequency. Short-duration bystander CPR caused injury in less than 2% of victims. Our results suggest that the benefits of bystander CPR for adults who suddenly collapse outweigh the risk of injury for those not in cardiac arrest.
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Comparative Study
Effectiveness of prehospital morphine, fentanyl, and methoxyflurane in pediatric patients.
To compare the effectiveness of intravenous morphine, intranasal (IN) fentanyl, and inhaled methoxyflurane for managing moderate to severe pain in pediatric patients in the out-of-hospital setting. ⋯ Intranasal fentanyl and intravenous morphine are equally effective analgesic agents in pediatric patients with moderate to severe acute pain in the out-of-hospital setting. Methoxyflurane is less effective in comparison with both morphine and fentanyl, but is an effective analgesic in the majority of children.
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Comparative Study
Comparison of first-attempt success between tibial and humeral intraosseous insertions during out-of-hospital cardiac arrest.
Intraosseous (IO) needle insertion is often utilized in the adult population for critical resuscitation purposes. Standard insertion sites include the proximal humerus and proximal tibia, for which limited comparison data are available. ⋯ In this subset of patients, tibial IO needle placement appeared to be a more effective insertion site than the proximal humerus. Success rates were higher with a lower incidence of needle dislodgments. Further randomized studies are required in order to validate these results.
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Comparative Study
Factors at the scene of injury associated with air versus ground transport to definitive care in a state with a large rural population.
Once emergency medical services (EMS) personnel decide to transport a trauma patient directly to definitive care, the next key decision at the scene of injury is whether to transport by air or ground. ⋯ Distance is the main factor in deciding whether to use air or ground EMS to transport a trauma patient from the scene of injury to a trauma center. With the exception of GCS <14, injury etiology was more strongly and consistently associated with the decision to transport by air than were patient related-factors. Identifying factors influencing the field transport decision will help develop transport guidelines that make efficient use of EMS resources.