Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2017
Observational StudyShould capnography be used as a guide for choosing a ventilation strategy in circulatory shock caused by severe hypothermia? Observational case-series study.
Severe accidental hypothermia can cause circulatory disturbances ranging from cardiac arrhythmias through circulatory shock to cardiac arrest. Severity of shock, pulmonary hypoperfusion and ventilation-perfusion mismatch are reflected by a discrepancy between measurements of CO2 levels in end-tidal air (EtCO2) and partial CO2 pressure in arterial blood (PaCO2). This disparity can pose a problem in the choice of an optimal ventilation strategy for accidental hypothermia victims, particularly in the prehospital period. We hypothesized that in severely hypothermic patients capnometry should not be used as a reliable guide to choose optimal ventilatory parameters. ⋯ Severe hypothermia seems to present an example of extremely large Pa-EtCO2 gradient. EtCO2 monitoring does not seem to be a reliable guide to ventilation parameters in severe hypothermia.
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Scand J Trauma Resus · Feb 2017
Developing quality indicators for physician-staffed emergency medical services: a consensus process.
There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS) are scarce. The aim of this study was to develop a set of quality indicators for international P-EMS to allow quality improvement initiatives. ⋯ The expert panel successfully developed a set of quality indicators for international P-EMS. The quality indicators should be prospectively tested for feasibility, validity and reliability in clinical datasets. The quality indicators should then allow for adjusted quality measurement across different P-EMS systems.
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Scand J Trauma Resus · Feb 2017
Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service.
Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. ⋯ Pre-hospital PRBC transfusion significantly reduces the time to transfusion for major trauma patients with suspected major haemorrhage. The majority of patients receiving pre-hospital PRBC were severely injured and required further transfusion in hospital. Further research is warranted to determine which patients are most likely to have outcome benefit from pre-hospital blood products and what triggers should be used for pre-hospital transfusion.
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Scand J Trauma Resus · Feb 2017
Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic.
The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. ⋯ Both primary missed diagnosis and diagnostic error have relatively low prevalence but have a serious impact on patients, hospitals and medical services. Planned follow up after adequate explanation can help to prevent diagnostic error and detect primary missed diagnosis, thereby reducing time to final diagnosis and risks for medico legal litigation. Reassessment of diagnostic error on a timely basis can be used as a key performance indicator in a quality assessment program.
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Scand J Trauma Resus · Feb 2017
Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients.
Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. ⋯ Thrombocytopenia on initial presentation might indicate an increased risk of AKI among elderly patients with medical illnesses.