Scand J Trauma Resus
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Scand J Trauma Resus · Jun 2021
Observational StudyAmbulance deceleration causes increased intra cranial pressure in supine position: a prospective observational prove of principle study.
Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position. ⋯ ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.
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Scand J Trauma Resus · Jun 2021
Randomized Controlled TrialComparison of different mechanical chest compression devices in the alpine rescue setting: a randomized triple crossover experiment.
Cardiopulmonary resuscitation in mountain environment is challenging. Continuous chest compressions during transport or hoist rescue are almost impossible without mechanical chest compression devices. Current evidence is predominantly based on studies conducted by urbane ambulance service. Therefore, we aimed to investigate the feasibility of continuous mechanical chest compression during alpine terrestrial transport using three different devices. ⋯ Mechanical chest compression devices provide a viable option in the alpine setting. For two out of three devices (Corpuls CPR and LUCAS 3) we found adequate quality of CPR. Those devices also maintained a correct placement of the piston even during challenging terrestrial transport. Adequate hands-off-times and correct placement could be achieved even by less trained personnel.
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Scand J Trauma Resus · Jun 2021
Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study.
Noninvasive ventilation (NIV) is recognized as first line ventilatory support for the management of acute pulmonary edema (APE) and chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to study the prehospital management of patients in acute respiratory distress with an indication for NIV and whether they received it or not. ⋯ The results of this study contribute to a better understanding of the prehospital management of patients who present with acute respiratory distress and an indication for NIV. NIV was started on clinically more severe patients, even if predefined criteria to start NIV were present. NIV allows to improve vital signs and D-VOS in those patients. A prospective study could further elucidate why patients with a suspected diagnosis of APE and COPD are not treated with NIV, as well as the clinical impact of the different strategies.
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Scand J Trauma Resus · Jun 2021
ReviewEducation in the placement of ultrasound-guided peripheral venous catheters: a systematic review.
Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. ⋯ Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.