Scand J Trauma Resus
-
Scand J Trauma Resus · Aug 2019
Prehospital cardiopulmonary resuscitation duration and neurological outcome after out-of-hospital cardiac arrest among children by location of arrest: a Nationwide cohort study.
Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests. ⋯ A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests.
-
Scand J Trauma Resus · Aug 2019
Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway - an interview study.
High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical services, the medical on-scene commander, in line with the command structure within the police and fire brigade, might support or take over command and control from the ambulance incident officer arriving as the first ambulance personnel on scene. The aim was to shed light on the emergency medical service experiences from real tunnel incidents described by the Oslo medical on-scene commanders. ⋯ The enthusiastic pioneers within the three emergency services have created a sense of familiarity and trust. A specially trained medical on-scene commander at a tunnel incident is regarded to improve the medical management. To improve efficiency, this might be worth studying for other emergency medical services with similar conditions, i.e. tunnels in densely populated areas.
-
Scand J Trauma Resus · Aug 2019
Practice GuidelineNew clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based.
Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. ⋯ The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process. This process yielded five main recommendations:A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.
-
Scand J Trauma Resus · Aug 2019
Clinical reasoning in the emergency medical services: an integrative review.
Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. ⋯ Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes.
-
Scand J Trauma Resus · Aug 2019
Multicenter Study Observational StudyEpinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study.
The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma. ⋯ The relationship between the use of epinephrine during resuscitation and decreased 7-day survival was found in patients with OHCA following trauma, and the propensity score-matched analyses validated the results. Resuscitation without epinephrine in traumatic OHCA should be further studied in a randomised controlled trial.