Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2016
Review Case ReportsAn evaluation of the Swiss staging model for hypothermia using case reports from the literature.
Core body temperature is used to stage and guide the management of hypothermic patients, however obtaining accurate measurements of core temperature is challenging, especially in the pre-hospital context. The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia. The proposed temperature range for clinical stage 1 is <35-32 °C (95-90 °F), for stage 2, <32-28 °C (<90-82 °F) for stage 3, <28-24 °C (<82-75 °F), and for stage 4 below 24 °C (75 °F). However, the evidence relating these temperature ranges to the clinical stages needs to be strengthened. ⋯ Predicting core body temperature using clinical indicators is a difficult task. Despite the inherent limitations of our study, it increases the strength of the evidence linking the clinical hypothermia stage to core temperature. Decreasing the thresholds of temperatures distinguishing the different stages would allow a reduction in the number of cases where body temperature is overestimated, avoiding some potentially negative consequences for the management of hypothermic patients.
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Scand J Trauma Resus · Feb 2016
Dyspnea, a high-risk symptom in patients suspected of myocardial infarction in the ambulance? A population-based follow-up study.
Systematic management of patients suffering high-risk symptoms is essential in emergency medical services. Patients with chest pain receive algorithm-based work-up and treatment. Though dyspnea is recognized as an independent predictor of mortality, no generally accepted prehospital treatment algorithm exists and this may affect outcome. The objective of this study was to compare mortality in patients suspected of myocardial infarction (MI) presenting with dyspnea versus chest pain in the ambulance. ⋯ Patients suspected of MI presenting with dyspnea have significantly higher short- and long-term mortality than patients with chest pain irrespective of a confirmed MI diagnosis. Future studies should examine if supplementary prehospital diagnostics can improve triage, facilitate early therapy and improve outcome in patients presenting with dyspnea.
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Scand J Trauma Resus · Feb 2016
Patient safety and patient assessment in pre-hospital care: a study protocol.
Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. ⋯ The findings will make an important contribution to knowledge about patient safety issues in pre-hospital care.
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Scand J Trauma Resus · Feb 2016
Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting.
Haemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA). ⋯ REBOA can be performed in ER and ICU with a high degree of technical success. Furthermore, correlations between occlusion time and initial high lactate levels and shock index may be important because prolonged occlusion is associated with a poorer outcome.
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Scand J Trauma Resus · Feb 2016
Use of the reverse shock index for identifying high-risk patients in a five-level triage system.
The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. To minimize undertriage in emergency departments (EDs), we evaluated whether RSI < 1 (i.e., SBP lower than HR) could be used as an additional variable to identify patients at high risk for more severe injury within a level category of the five-level Taiwan Triage and Acuity Scales (TTAS) system. ⋯ RSI < 1 upon arrival at an ED is an alarming sign of an associated worse outcome. Within the same triage level from level I to level III, patients with RSI < 1 had worse outcomes than those with RSI ≥ 1. The inclusion of RSI in the TTAS system may help to identify patients with more serious injuries who need an upgraded management level.