Articles: emergency-medical-services.
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Observational Study
Associations between emergency call stroke triage and pre-hospital delay, primary hospital admission, and acute reperfusion treatment among early comers with acute ischemic stroke.
To investigate the association between the Emergency Medical Service dispatcher's initial stroke triage and prehospital stroke management, primary admission to hospitals offering revascularization treatment, prehospital time delay, and rate of acute revascularization. In an observational cohort study, patients with acute ischemic stroke (AIS) in Denmark (2017-2018) were included if the emergency call to the Emergency Medical Dispatch Center (EMDC) was made within three hours after symptom onset. Among 3546 included AIS patients, the EMS dispatcher identified 74.6% (95% confidence interval (CI) 73.1-76.0) correctly as stroke. ⋯ For all AIS patients, the adjusted difference was - 33.2 min (95% CI - 44.4; - 22.0). Among patients receiving acute revascularization treatment (n = 1687), the adjusted difference was -12.6 min (95% CI - 18.9; - 6.3). Stroke recognition by the EMS dispatcher was associated with a higher probability of primary admission to a hospital offering acute stroke treatment, and subsequently with a higher rate of acute revascularization treatment, and with an overall reduction in prehospital delay.
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JNMA J Nepal Med Assoc · Nov 2023
Case ReportsCervical Ectopic Pregnancy with Unsupervised Intake of Medications for Abortion: A Case Report.
Cervical ectopic pregnancy is the rarest form of ectopic pregnancy, where implantation occurs in the mucosa of the endocervical canal, below the internal os. Medical abortion is a safe and effective method of termination of early intrauterine pregnancies when carried out under the supervision of trained service providers. Unfortunately, unsupervised misuse of such methods can lead to grave morbidities, especially in ectopic pregnancies. We report a case of a 29-year-old female with cervical ectopic pregnancy, with a history of self-induced medical abortion. Her assumption that her pregnancy had been terminated caused a delay in seeking treatment, which led to complications during management. Ultrasonography revealed features suggestive of cervical ectopic pregnancy and evacuation of the fetus and placenta was done using curettage, during which she had uncontrolled severe vaginal bleeding leading to need of emergency hysterectomy. ⋯ case reports; cervical; ectopic pregnancy; hysterectomy; induced abortion.
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Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. We conducted a systematic review on the impact of sociodemographic factors across different stages of POHCA. ⋯ Race and ethnicity are likely associated with POHCA risk and bystander CPR provision. These findings highlight the importance of prioritizing at-risk groups in POHCA prevention and intervention efforts. Further research is needed to understand underlying mechanisms.
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To analyze differences in ventilatory parameters and outcome with different ventilatory methods during CPR. ⋯ The use of a mechanical ventilator in IPPV was associated with a better ventilatory status during CPR compared to the use of the bag, without conclusive data regarding its clinical repercussion with the sample collected.