Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2019
Comparative StudyComparison of two different intraosseous access methods in a physician-staffed helicopter emergency medical service - a quality assurance study.
Intravenous access in critically ill and injured patients can be difficult or impossible in the field. Intraosseous access is a well-established alternative to achieve access to a noncollapsible vascular network. We wanted to compare the use of a sternal and tibial/humeral intraosseous device in a physician-staffed helicopter emergency medical service. ⋯ Intraosseous access seems to be a reliable rescue technique in our helicopter emergency medical service, with high insertion success rates. EZ-IO was a more rapid method in gaining vascular access compared to FAST-Responder. However, FAST-Responder may be a better method when high-flow infusion is needed. Few complications were registered with both techniques in our service.
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Scand J Trauma Resus · Feb 2019
Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? - a retrospective study.
Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics. ⋯ These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.
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Scand J Trauma Resus · Feb 2019
Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands.
Little evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands. ⋯ The current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.
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Scand J Trauma Resus · Feb 2019
Observational StudyImpact of icing weather conditions on the patients in helicopter emergency medical service: a prospective study from Northern Finland.
A high number of denied or cancelled HEMS missions are caused by poor weather conditions especially during winter season. Furthermore, many helicopter manufacturers have denied their helicopters to be operated in known icing conditions. Icing is a widely known phenomenon in aviation, but there is a lack of evidence about its influence on HEMS operations and patients. ⋯ In this study the incidence of icing weather conditions was substantial compared to all HEMS missions in year 2017. The delay in definitive treatment was accentuated among trauma and internal medicine patients. During the 1-year study period many patients whose definitive treatment was delayed would have had a notable (> 60 min) time saved by helicopter transport. A helicopter equipped with an adequate ice protection system for the weather conditions in Northern Finland would have shortened the delay in patients' definitive treatment significantly.
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Scand J Trauma Resus · Feb 2019
Editorial CommentPermissive hypotensive resuscitation in patients with traumatic hemorrhagic shock.
We read the article "Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis" by Natthida Owattanapanich et al. with great interest and found it to be insightful. In our commentary, we propose possible reasons why mortality was lower in the permissive hypotension group and how the need for blood transfusion decreased in this group. No significant difference in acute kidney injury (AKI) was evident among patient groups, possibly because all these patients might have AKI. However, we do agree that permissive hypotension is of considerable benefit to trauma patients and worth further study.