Scand J Trauma Resus
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Scand J Trauma Resus · Apr 2018
Letter Observational StudyImplementation of a mechanical CPR device in a physician staffed HEMS - a prospective observational study.
In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. ⋯ Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.
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Scand J Trauma Resus · Apr 2018
Multicenter StudyTemporal phenotyping of circulating microparticles after trauma: a prospective cohort study.
After severe polytrauma the dynamic process of coagulation may deteriorate towards a trauma-induced coagulopathy (TIC) promoting a dramatic increase in morbidity and mortality. Recent evidence suggests that microparticles (MPs) play a pivotal role at the interface between cellular and plasmatic coagulation systems. However, the impact of MPs on functional coagulation has not been clarified yet in the setting of traumatic injuries. We assessed the temporal patterns of circulating MP concentrations including their cellular origin in the context of clinical presentation and global coagulation assays. ⋯ In conclusion, this study could demonstrate that PDMP and EDMP levels increase significantly following polytrauma correlating with injury severity. Although severe coagulopathy was not observed, EDMP levels were associated with improved coagulation parameters suggesting their essential role for regulating blood coagulation after trauma.
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Scand J Trauma Resus · Apr 2018
Multicenter StudyThe epidemiology of mild traumatic brain injury: the Trondheim MTBI follow-up study.
Mild traumatic brain injury (MTBI) is a frequent medical condition, and some patients report long-lasting problems after MTBI. In order to prevent MTBI, knowledge of the epidemiology is important and potential bias in studies should be explored. Aims of this study were to describe the epidemiological characteristics of MTBI in a Norwegian area and to evaluate the representativeness of patients successfully enrolled in the Trondheim MTBI follow-up study. ⋯ Two thirds of all patients with MTBI in the 16-60 age group were treated without hospital admission, patients were often young, and half of the patients presented during the weekend. Fall was the most common cause of injury, and patients were commonly injured under the influence of alcohol, which needs to be addressed when considering strategies for prevention. The Trondheim MTBI follow-up study comprised patients who were highly representative for the underlying epidemiology of MTBI.
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Scand J Trauma Resus · Apr 2018
Primary mass casualty incident triage: evidence for the benefit of yearly brief re-training from a simulation study.
Triage is a mainstay of early mass casualty incident (MCI) management. Standardized triage protocols aim at providing valid and reproducible results and, thus, improve triage quality. To date, there is little data supporting the extent and content of training and re-training on using such triage protocols within the Emergency Medical Services (EMS). The study objective was to assess the decline in triage skills indicating a minimum time interval for re-training. In addition, the effect of a one-hour repeating lesson on triage quality was analyzed. ⋯ To improve disaster preparedness, triage skills should be refreshed yearly by a brief re-education of all EMS providers.
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Scand J Trauma Resus · Apr 2018
Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage - a cross sectional study.
No consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU®, at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement. ⋯ Application of ERTTAC as published for TraumaNetwork DGU® resulted in a lower undertriage but higher overtriage rate than recommended by the American College of Surgeons. Omitting the criterion 'passenger of car or truck' markedly improved overtriage with only a minimal increase in undertriage.