Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2019
Multicenter Study Observational StudyImpact of initial coagulation and fibrinolytic markers on mortality in patients with severe blunt trauma: a multicentre retrospective observational study.
Acute coagulopathy is a well-known predictor of poor outcomes in patients with severe trauma. However, using coagulation and fibrinolytic markers, how one can best predict mortality to find out potential candidates for treatment of coagulopathy remains unclear. This study aimed to determine preferential markers and their optimal cut-off values for mortality prediction. ⋯ Fibrinogen and D-dimer were the principal markers for stratification of mortality in patients with severe blunt trauma. These markers could function as therapeutic targets because they were significant predictors of mortality, independent from severity of injury.
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Scand J Trauma Resus · Feb 2019
Changes in anaesthetic use for trauma patients in German HEMS - a retrospective study over a ten-year period.
Airway management and use of intravenous anaesthetics to facilitate tracheal intubation after major trauma remains controversial. Numerous agents are available and used for pre-hospital rapid-sequence induction (RSI). The aim was to investigate usage and potential changes in administration of intravenous anaesthetics for pre-hospital RSI in trauma patients over a ten-year period. ⋯ This large study analysed prehospital administration of anaesthetics in trauma patients, showing a substantial change from 2006 to 2015 despite the lack of any high-level evidence. Etomidate has shifted from the main sedative substance to virtual absence, indicating that the recommendation of an established national guideline was transferred into clinical practice, although based on weak evidence as well. The pre-hospital use of Propofol showed a particular increase. Fentanyl has been the main opioid drug for RSI in trauma, however Sufentanyl has become increasingly popular. The mechanisms and advantages of the different substances still have to be elucidated, especially in head injury and bleeding trauma.
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Scand J Trauma Resus · Feb 2019
Case ReportsInhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension.
We describe a case where inhaled nitric oxide (iNO) was successfully initiated during cardiopulmonary resuscitation (CPR) in a younger patient with cardiac arrest related to pulmonary hypertension after disseminated intravascular coagulation (DIC) postpartum bleeding and hysterectomy. This case illustrates that iNO might be a potential lifesaving tool for resuscitation of patients with cardiac arrest related to pulmonary hypertension, for whom most other resuscitation strategies often are futile.
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Scand J Trauma Resus · Feb 2019
LetterConnect dispatch centers for call handling improves performance.
The aim of this Letter to the Editor was to report a strategy to reduce time waiting for emergency calls in a dispatch center, in line with a recently published article that reviewed evidence for medical dispatching systems to accurately dispatch Emergency medical Services. Here, we tested the effect of a connected distribution of calls, where a call is allocated to the first available resource among a pooled group of telecommunicators from several dispatch centers. We found that connect dispatch centers improve dispatch center performance, especially during an overloaded period. It could be leveraged to handle emergency calls without delay and to appropriately dispatch Emergency Medical Services.
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In bacteremia the majority of bacterial species are killed by oxidation on the surface of erythrocytes and digested by local phagocytes in the liver and the spleen. Sepsis-causing bacteria overcome this mechanism of human innate immunity by versatile respiration, production of antioxidant enzymes, hemolysins, exo- and endotoxins, exopolymers and other factors that suppress host defense and provide bacterial survival. ⋯ A bacterium killing is only one of numerous aspects of antibacterial therapy. The latter should inhibit the production of bacterial antioxidant enzymes and hemolysins, neutralize bacterial toxins, modulate bacterial respiration, increase host tolerance to bacterial products, facilitate host bactericidal mechanism and disperse bacterial capsule and biofilm.