Articles: emergency-medical-services.
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Maximum benefit from thrombolytic therapy in acute myocardial infarction is obtained with early therapy. The earliest possible time to treat is during the initial evaluation of the patient in the home or ambulance, which requires accurate diagnosis of acute myocardial infarction in the prehospital setting. In our study, paramedics evaluated patients who had chest pain with a 12-lead ECG transmitted by cellular telephone and a checklist for inclusion and exclusion criteria for thrombolytic therapy. ⋯ Prehospital ECG diagnosis resulted in two patients going directly to the catheterization lab, thereby bypassing the emergency department. Overt acute myocardial infarction can be accurately identified by a prehospital-acquired 12-lead ECG transmitted to a hospital-based physician. Our study demonstrates that in conjunction with specially trained paramedics, the hospital physician can decide whether to administer thrombolytic therapy to such patients in the prehospital setting.
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To determine the outcomes of patients who did not regain vital signs after prehospital advanced cardiac life support, we studied adult patients who sustained nontraumatic out-of-hospital cardiac arrest. Our study consisted of a 20-month retrospective review of 244 charts beginning January 1986. Twelve patients were excluded for drug overdose, family request, or unavailable data. ⋯ Survival to hospital admission did not correlate with any of the variables studied except gender. The one patient who survived a failed prehospital resuscitation was not endotracheally intubated in the field. Our data support the practice of pronouncing adult nontraumatic cardiac arrest victims who fail to respond to advanced cardiac life support efforts in the field as dead at the scene.
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We investigated the emergency service at Reinosa to evaluate the following: equipment, characteristics, performance (policies, criteria of use of transport), and the type of the attending patients, demand for care and severity. Attention was given to 8,039 patients, with a monthly mean of 674,416 +/- 21,750 and male predominance. ⋯ Our study shows that 96.34% of the demand can be correctly cared for with an adequate equipment. This type of services should be encouraged as they are highly cost effective from the social, health care and economic points of view.
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The Trauma Score (TS) has been revised. The revision includes Glasgow Coma Scale (GCS), systolic blood pressure (SBP), and respiratory rate (RR) and excludes capillary refill and respiratory expansion, which were difficult to assess in the field. Two versions of the revised score have been developed, one for triage (T-RTS) and another for use in outcome evaluations and to control for injury severity (RTS). ⋯ RTS is a weighted sum of coded variable values. The RTS demonstrated substantially improved reliability in outcome predictions compared to the TS. The RTS also yielded more accurate outcome predictions for patients with serious head injuries than the TS.
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Field triage of injured patients has the objective of rapid identification of that 5-10% with injuries serious enough to pose a risk to life. The process requires not only the identification of patients with abnormal physiology, but also those whose physiology is normal despite the fact that significant anatomic injury may exist. ⋯ The amount of vehicle damage observed with these velocity changes was found to be 20 inches of crush in direct frontal collisions, 28 inches of crush in offset frontal collisions, and 15 inches of damage in side impacts. Incorporating these findings into triage of trauma patients who exhibit normal vital signs at the accident scene may provide a more structured basis for field triage.