Articles: emergency-medical-services.
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There is no current training or experience that can closely parallel operating in the combat theater. However, the use of a structured and systematic approach to patient care such as Advanced Trauma Life Support would have given those thrust into trauma care a format to build upon.
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This study reviews 186 deaths resulting from trauma in a 2-year period in the Charity Hospital of Louisiana at New Orleans Accident Room in order to evaluate problems in prehospital and hospital resuscitative care. All subjects underwent autopsy, and only six were found to have injuries compatible with survival. Three of these were late arrivals (by transfer or self-imposed delay) and died of protracted hemorrhage. ⋯ The important factors in maximizing survival of trauma patients remain rapid transport; immediate, appropriate, rapid evaluation; and quick diagnosis, resuscitation, and definitive therapy. These require a well-trained emergency medical ambulance service delivering patients quickly to a hospital designed to handle trauma patients. One person, preferably a general surgeon with trauma experience, should supervise and monitor the patient continually until the resuscitation phase and all diagnostic tests are completed and definitive therapy is initiated.
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Prehosp Disaster Med · Apr 1990
Prehospital and emergency department verification of endotracheal tube position using a portable, non-directable, fiberoptic bronchoscope.
Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. ⋯ FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be "difficult." FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.