Articles: trauma.
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Prehospital traumatic cardiac arrest (TCA) is associated with a poor prognosis and requires urgent interventions to address its potentially reversible causes. Resuscitative efforts of TCA in the prehospital setting may entail significant resource allocation and impose added tolls on caregivers. The Israel Defense Forces Medical Corps (IDF-MC) instructs clinicians to perform a set protocol in the case of TCA, providing prompt oxygenation, chest decompression and volume resuscitation. This study investigates the settings, interventions, and outcomes of TCA resuscitation by IDF-MC teams over 25 years in both combat and civilian settings. ⋯ The prognosis of prehospital TCA is poor, and efforts to address its potentially reversible causes may often be futile. These notions may be further emphasized in military settings, where resources are limited, and extensive penetrating injuries are more common.
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Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. Work in the HEMS setting is characterized by frequent exposure to critical incidents and other stressors. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing to inform organizations regarding workplace interventions that can be implemented to support employees. ⋯ This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. Findings from this study may benefit employers by shedding much-needed light on factors that HEMS personnel feel affect wellbeing.
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Multicenter Study
Development of a prediction model for emergency medical service witnessed traumatic out-of-hospital cardiac arrest: A multicenter cohort study.
To develop a prediction model for emergency medical technicians (EMTs) to identify trauma patients at high risk of deterioration to emergency medical service (EMS)-witnessed traumatic cardiac arrest (TCA) on the scene or en route. ⋯ We established a prediction model using variables from the PATOS database and measured them immediately after EMS personnel arrived to predict EMS-witnessed TCA. The model allows prehospital medical personnel to focus on high-risk patients and promptly administer optimal treatment.
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A Trauma Team Activation (TTA) is initiated when a patient has sustained a life or limb-threatening injury thereby necessitating resources of a large care team. Previously, a CT scanner was cleared at the time of the prehospital TTA call. Wide variability in the time it took to stabilize patients often led to extended CT scanner idle time. A new policy was developed whereby the team leader would prompt the ED clerk to provide a '5-min heads-up' (5-min HU) notification to the CT scanner personnel as a patient was stabilized. At this point, the CT scanner was cleared. The purpose of this quality improvement project is to evaluate if the new policy saves CT scanner idle time. ⋯ These data support the implementation of a 5-min HU policy in the ED for patients arriving as TTAs. This maximizes the availability of CT scanners for other patients in the ED while TTA patients are being stabilized.
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Case Reports
Not Your Typical Sore Throat-A Case Report on Delayed Complications From Cervical Spinal Surgery.
Esophageal perforation is an uncommon illness with a mortality rate as high as 50%. It is most frequently caused by iatrogenic instrumentation for both diagnostic and therapeutic purposes. Noniatrogenic spontaneous ruptures account for 15% of cases, followed by traumatic injury and rupture secondary to a foreign body.1 Sore throat is a common emergency medicine complaint with an array of causes and severity of pathology. We report a case of a sore throat resulting from esophageal perforation and prevertebral abscess as delayed complications from an anterior cervical surgery.