Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2015
ReviewTransfusion therapy in paediatric trauma patients: a review of the literature.
Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT). Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. ⋯ MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising. Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted.
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Scand J Trauma Resus · Jan 2015
Multicenter StudyAccidental hypothermia in Poland ¿ estimation of prevalence, diagnostic methods and treatment.
The incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs). ⋯ The actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia.
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Scand J Trauma Resus · Jan 2015
Situational awareness and information flow in prehospital emergency medical care from the perspective of paramedic field supervisors: a scenario-based study.
In prehospital emergency medical services, one of the key factors in the successful delivery of appropriate care is the efficient management and supervision of the area's emergency medical services units. Paramedic field supervisors have an important role in this task. One of the key factors in the daily work of paramedic field supervisors is ensuring that they have enough of the right type of information when co-operating with other authorities and making decisions. However, a gap in information sharing still exists especially due to information overload. The aim of this study was to find out what type of critical information paramedic field supervisors need during multi-authority missions in order to manage their emergency medical services area successfully. The study also investigated both the flow of information, and interactions with the paramedic field supervisors and the differences that occur depending on the incident type. ⋯ Paramedic field supervisors communicate actively with EMS units and other authorities such as Emergency Medical Dispatch, police, and rescue services during the multi-authority incidents. This study provides knowledge about the critical information categories when receiving and sharing the information to obtain and maintain situational awareness. However, further research is needed to examine more the information flow in prehospital emergency care to enable a better understanding of required communication in situational awareness formation.
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Scand J Trauma Resus · Jan 2015
Comparative StudyAnaesthetist-provided pre-hospital advanced airway management in children: a descriptive study.
Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). ⋯ Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital advanced airway management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital airway management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital advanced airway management.
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Scand J Trauma Resus · Jan 2015
Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 - a cross-sectional study.
Norway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS). ⋯ First responders were exposed to deaths, injuries, and destruction, but few reported this as highly stressful. The prevalence of possible PTSD was low in all occupational groups, and symptoms of dissociation were found to be the most important predictor.