Scand J Trauma Resus
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Scand J Trauma Resus · Jan 2014
Screening, detection and management of delirium in the emergency department - a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED).
Delirium in emergency department (ED) patients occurs frequently and often remains unrecognized. Most instruments for delirium detection are complex and therefore unfeasible for the ED. The aims of this pilot study were first, to confirm our hypothesis that there is an unmet need for formal delirium assessment by comparing informal delirium ratings of ED staff with formal delirium assessments performed by trained research assistants. Second, to test the feasibility of an algorithm for delirium screening, detection and management, which includes the newly developed modified Confusion Assessment Method for the Emergency Department (mCAM-ED) at the ED bedside. Third, to test interrater reliability of the mCAM-ED. ⋯ Informal assessment of delirium is inadequate. The mCAM-ED proved to be useful at the ED bedside. Performance criteria need to be tested in further studies. The mCAM-ED may contribute to early identification of delirious ED patients.
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Scand J Trauma Resus · Jan 2014
Randomized Controlled TrialComparison of CPR quality and rescuer fatigue between standard 30:2 CPR and chest compression-only CPR: a randomized crossover manikin trial.
We aimed to compare rescuer fatigue and cardiopulmonary resuscitation (CPR) quality between standard 30:2 CPR (ST-CPR) and chest compression only CPR (CO-CPR) performed for 8 minutes on a realistic manikin by following the 2010 CPR guidelines. ⋯ The rate and number of adequate CCs were significantly lower with the CO-CPR than with the ST-CPR after 2 and 6 minutes, respectively, and performer fatigue was higher with the CO-CPR than with the ST-CPR during 8 minutes of CPR.
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Scand J Trauma Resus · Jan 2014
Clinical review is essential to evaluate 30-day mortality after trauma.
Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We examined the proportion of trauma patients dying within 30 days from causes not related to the injury and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics, injury characteristics, cause of death and time to death in patients admitted to our trauma center who died within 30 days, between 2007-2011. ⋯ Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly affected the unadjusted mortality rate, ISS, median age and time to death.
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Scand J Trauma Resus · Jan 2014
The use of transcutaneous CO2 monitoring in cardiac arrest patients: a feasibility study.
Prediction of the return of spontaneous circulation (ROSC) in cardiac arrest patients is a parameter for deciding when to stop cardiopulmonary resuscitation (CPR) or to start extracorporeal CPR. We investigated the change in transcutaneous PCO2 (PtcCO2) in cardiac arrest patients. ⋯ PtcCO2 monitoring provides non-invasive, continuous, and useful monitoring in cardiac arrest patients.
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Scand J Trauma Resus · Jan 2014
Screening and management of major bile leak after blunt liver trauma: a retrospective single center study.
Major bile leak after blunt liver trauma is rare but challenging. It usually requires endoscopic retrograde cholangiography (ERC) for management. However, there is still lack of specific indications. The aim of this study is to elucidate risk factors for major bile leak and indications for early ERC after blunt liver trauma. ⋯ High injury grade; centrally-located liver trauma; and use of TAE are risk factors for major bile leak after blunt liver trauma. ERC should be arranged early if the patient has risk factors and their plasma bilirubin level is greater than 43.6 μmol/L during admission.