Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2010
Comparative StudyISS mapped from ICD-9-CM by a novel freeware versus traditional coding: a comparative study.
Injury severity measures are based either on the Abbreviated Injury Scale (AIS) or the International Classification of diseases (ICD). The latter is more convenient because routinely collected by clinicians for administrative reasons. To exploit this advantage, a proprietary program that maps ICD-9-CM into AIS codes has been used for many years. Recently, a program called ICDPIC trauma and developed in the USA has become available free of charge for registered STATA users. We compared the ICDPIC calculated Injury Severity Score (ISS) with the one from direct, prospective AIS coding by expert trauma registrars (dAIS). ⋯ Despite its great potential convenience, ICPIC-ISS agreed poorly with its conventionally calculated counterpart. Its discriminative power for survival was also significantly lower. Incomplete ICD-9-CM coding was a main cause of these findings. Because this quality of coding is standard in Italy and probably in other European countries, its effects on the performances of other trauma scores based on ICD administrative data deserve further research. Mapping ICD-9-CM code 862.8 to AIS of 6 is an overestimation.
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Scand J Trauma Resus · Jan 2010
Extracorporeal life support for management of refractory cardiac or respiratory failure: initial experience in a tertiary centre.
Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals. ⋯ In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.
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Scand J Trauma Resus · Jan 2010
End-tidal carbon dioxide monitoring during bag valve ventilation: the use of a new portable device.
For healthcare providers in the prehospital setting, bag-valve mask (BVM) ventilation could be as efficacious and safe as endotracheal intubation. To facilitate the evaluation of efficacious ventilation, capnographs have been further developed into small and convenient devices able to provide end- tidal carbon dioxide (ETCO2). The aim of this study was to investigate whether a new portable device (EMMA™) attached to a ventilation mask would provide ETCO2 values accurate enough to confirm proper BVM ventilation. ⋯ The portable device, EMMA™ is suitable for determining carbon dioxide in expired air (kPa) as compared to simultaneous samples of PvCO2. It could therefore, be a supportive tool to asses the BVM ventilation in the demanding prehospital and emergency setting.
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Scand J Trauma Resus · Jan 2010
Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria.
Incidence of Blunt Cerebrovascular Injuries (BCVI) after head injury has been reported as 0.5-1% of all admissions for blunt trauma, with a high stroke and mortality rate. The purpose of this study is to evaluate if a modification of Memphis criteria could improve the rate of BCVI diagnosis. ⋯ A modification of a single criteria of Memphis screening protocol might permit the identification of a higher percentage of BCVI. Limited by sample size, this study needs to be validated.
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CPR has a proven role in improving survival in cardiac arrest victims, especially those who are outside the hospital. Guidelines published by the AHA have included CPR as a vital intervention for decades. The previous guidelines have focused on the maintenance of airway as the first step, there by delaying the provision of chest compressions. However, the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care corrects this by changing the A-B-C of CPR to C-A-B, acknowledging that chest compressions are the most important aspect of the cardiac arrest management.