Medical Emergency Situations Research Articles

Inflammatory Activation after Experimental Cardiac Tamponade

Background/Purpose: Cardiac tamponade is a medical emergency situation associated with a high rate of life-threatening complications, even after immediate interventions. Our aim was to characterize the acute inflammatory consequences of this event in a clinically relevant large animal model. Methods: Cardiac tamponade was induced for 60 min in anesthetized, ventilated and thoracotomized minipigs by intrapericardial fluid administration, the mean arterial pressure (MAP) being maintained in the interval of 40-45 mm Hg (n = 8). A further group (n = 7) served as sham-operated control. The global macrohemodynamics, including the right- and left-heart end-diastolic volumes (RHEDV and LHEDV), the pulmonary vascular resistance index (PVRI) and the superior mesenteric artery (SMA) flow, were monitored for 240 min, and the intestinal microcirculatory changes (pCO₂ gap) were evaluated by indirect tonometry. Blood samples were taken for the determination of cardiac troponin T and vasoactive inflammatory mediators, including histamine, nitrite/nitrate, big-endothelin, superoxide and high-mobility group box protein-1 levels in association with intestinal leukocyte and complement activation. Results: The cardiac tamponade induced significant decreases in MAP, cardiac output, LHEDV and SMA flow, while the PVRI and the pCO₂ gap increased significantly. After the removal of fluid from the pericardial sac, the MAP and the LHEDV were decreased, while the PVRI and the pCO₂ gap remained elevated when compared with those in the sham-operated group. In the posttamponade period, the abrupt release of inflammatory mediators was accompanied by a significant splanchnic leukocyte accumulation and complement activation. Conclusions: The macrocirculatory and splanchnic microcirculatory disturbances were accompanied by a significant proinflammatory reaction; endothelin and the complement system may be significant components of the inflammatory cascade that is activated in this porcine model of pericardial tamponade.

Protocol Stack based Security Vulnerabilities in MANETs

Mobile Ad-hoc network is a temporary network of mobile nodes where mobile nodes communicate with each other through wireless links with no fixed infrastructure & no centralized control. Each mobile node in such a scenario acts as both a router & host. Nodes within each other's radio range communicate directly, while those other nodes that are far apart used as relays. Thus the nodes find a path to the destination node using routing protocols. Minimal configuration & quick deployment make them suitable for emergency situations like war, emergency medical situations etc. Since Mobile Ad-hoc networks lack an infrastructure, they are exposed to a lot of vulnerabilities. In this paper, we present a survey on the protocol stack based security vulnerabilities in MANETs. All these vulnerabilities attempt to affect the overall performance and throughput of the network. The intent of this paper is to classify and explain the security vulnerabilities in the MANET protocol stack.

High-Fidelity Simulations for Orthopaedic Residents

Surgical training requires acquisition of procedural skills as well as competency in medical management. Changes in training and practice patterns have decreased the operative and nonoperative experiences of trainees. With the introduction of new technologies, more complex procedures, and a host of external constraints, the doctrine of learning primarily through supervised patient-care experiences has been superseded by efforts to teach in nonclinical environments1. Increasingly, simulation is being used to help learners develop essential operative technical skills to compensate for the loss of experience that historically has been obtained through exposure to cases. Hip fixation, osteotomy and fusion, and arthroscopy are some of the orthopaedic procedures that are taught through simulation2-4. Despite the attempts to compensate for decreased opportunities for procedural competency training, to our knowledge no one has developed an alternate method to teach clinical skills needed by orthopaedic residents to manage patients in the postoperative period. Residents develop the ability to manage emergency medical situations through exposure to patient problems, just as motor memory is developed through repetitive performance of a procedure. Feedback from more experienced physicians is another important component of learning proper medical management of patients. Whereas operative skill is supervised, thereby providing opportunities for immediate feedback and improvement, postoperative care receives less scrutiny. The simulated setting is an ideal place to practice handling medical emergencies in a standardized manner. Simulation-based medical education is recognized as a method of boosting medical professional performance while enhancing patient safety5. It is being used at a rapidly expanding rate for training of health-care providers, including pediatrics, internal medicine, and anesthesia residents, and for medical students, but we believe that this is the first description of a simulation-based medical education course focusing on postoperative care by orthopaedic residents. Our hypothesis was that simulation-based …

Views of Childhood Cancer Survivors and Their Families on the Provision and Format of a Treatment Summary

Summaries of diagnosis, treatments, and their potential late adverse health effects (treatment summaries) are increasingly being provided routinely to survivors of childhood cancer. There is relatively little research into opinions of service users on the provision and format of treatment summaries. Semistructured interviews were conducted with 24 survivors of childhood cancer, and 25 parents of 20 of these survivors (n=49) were asked to explore these issues. Survivors were aged 4 to 22 years, with a range of previous oncological diagnoses. The mean (range) interval since treatment completion was 4.5 (0.5 to 13) years. Twelve survivors (50%) and 16 parents (64%) fully supported the use of treatment summaries as: a memory aid, a reference tool for planned and emergency medical situations, life and financial planning, and to promote ownership of health. Four survivors felt they did not want, or did not need, a reminder of their medical past. Most participants (63% of survivors) desired a verbal explanation plus a written A4 paper treatment summary. However, other formats (wallet sized, audio guides) were suggested to address practical and individual needs raised by participants. Most service users would benefit from treatment summaries, although notably not all. The format and timing of the provision need to be carefully considered.

Cardiopulmonary Resuscitation Training in High School Using Avatars in Virtual Worlds: An International Feasibility Study

BackgroundApproximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today’s youth (ie, the digital native generation).ObjectiveOur main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training.MethodsIn this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables.ResultsThe participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use.ConclusionsBy using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.

Medication Errors in Pediatric Emergencies

Errors in drug administration are among the commonest medical errors. Children are particularly at risk for such errors because of the need to calculate doses individually. Doses that are ten times the correct amount (1000% of the correct dose) are occasionally given and can be life-threatening. In a simulated resuscitation in a pediatric emergency room, an error of this type occurred for one of the 32 medications that were ordered. The highest error rates are to be expected in prehospital emergency medicine. In this review, we analyze the process of ordering medications and describe the potential interventions for lowering error rates that have been evaluated to date. Systematic literature review We found 32 original publications that concerned the evaluation of interventions for lowering error rates in the ordering of medications for children. Error rates can be lowered by interventions that improve prescribers' knowledge of pediatric pharmacotherapy (courses, immediately accessible sources of information) and by aids to the cognitive process of ordering medication (calculators, computer programs, tables of doses by weight). They can also be lowered by raising awareness of the problem of erroneous medication ordering and by monitoring medication orders, as well as by structured communication and standardized, unambiguously labeled drug preparations. In the hospital setting, computer programs for medication orders with a built-in pediatric pharmacological database are highly recommended. In the prehospital setting, the "pediatric emergency ruler" enables accurate estimation of the patient's weight, provides age-appropriate dosage recommendations, and directly indicates the steps needed for calculation of the correct dose. Children in medical emergency situations are at significant risk for medication errors. The measures described here can markedly lower the rate of dangerous errors.

An assessment of community pharmacists' responses to hypothetical medical emergency situations

To investigate community pharmacists' proposed actions in hypothetical medical emergency situations in South-East Queensland, Australia. A survey was posted to 151 Gold Coast and Toowoomba community pharmacies in October 2009. Pharmacists were asked to document their opinions regarding the pharmacist's role in medical emergencies and to respond to statements associated with two hypothetical medical emergency situations: an anaphylaxis and an asthma attack. Forty-five pharmacists responded to the survey (29.8%). In response to a hypothetical situation involving an asthma attack, 41 pharmacists (91.1%) agreed that they would assist the asthmatic person to administer salbutamol through a spacer, with 28 pharmacists (62.2%) confident in treating an asthma attack in the pharmacy. In comparison, only 21 pharmacists (21/38; 55.3%) agreed to administer an adrenaline auto-injector (Epi-Pen) for a child experiencing an anaphylaxis, with nine respondents (9/38; 23.7%) indicating that they would ask the mother for directions in a situation where they were unsure how to administer it. There were comments questioning whether indemnity insurance covers pharmacists for medicine administration, and 12 pharmacists (12/38; 31.6%) indicated that if they were unsure about insurance cover they would ask the mother to administer the adrenaline. Pharmacists' responses to administering medications in hypothetical medical emergencies were variable. The cause of this variation is multi-factorial and likely to include familiarity with the medication, its safety profile and uncertainty about the pharmacist's role and responsibilities in these situations. Further clarification, training and guidelines are needed in order to address this.

Bearing the Brunt of the New Regulations: Minority Populations

In an ideal world, the new FDA regulations permitting research without consent could have the potential to help hundreds of thousands of people in emergency medical situations. Ideally, those who suffer strokes, drug overdoses, cardiac arrests, and traffic and gunshot wounds would benefit. If able to give consent, most trauma patients would probably want the innovative interventions that investigators propose. For most people, then, emergency medical research without consent presents no ethical dilemma. In an ideal world institutional racism, sexism, and classism would play no part in the selection of research subjects. The benefits and risks of research would be fairly distributed among the population. However, we do not live in an ideal world. Research is not primarily for the benefit of the individual subjects, but rather for scientific knowledge that will benefit people in the future. In the world we live in, researchers have reputations to make; IRBs are not always vigilant in protecting the rights and welfare of the research subjects; individuals are sometimes harmed by experimental medicine; and vulnerable populations--ethnic minorities, children, prisoners, and poor people--have always been fair game for unethical medical research. The new rules will have a significant impact on ethnic minorities, particularly African Americans. For at least three reasons, implementation of research without consent will be problematic for minority populations. First, African Americans, Hispanics, and poor people will be disproportionately the subjects of experimentation without informed consent. Because of the location of trauma centers and because of the disproportionately high rate of certain kinds of trauma, poor people and people of color will probably bear a great deal of the burdens of research. While trauma centers serve people from all walks of life, regardless of race, ethnicity, sex, age, or class, a large proportion of trauma centers are located in public hospitals in or near inner cities. Because public hospitals are often associated with universities, they are also sites for teaching and medical research. For example, the Los Angeles County-University of Southern California Medical Center is the country's largest teaching hospital and also the nation's second largest public health system, caring for 28 percent of all major trauma victims in Los Angeles County.[1] Emergency research will most likely take place in poor communities because that's where the hospitals with sophisticated and well-run trauma centers are located. A disporportionately large number of research subjects will likely be Hispanic and African Americans because of the large number of firearm--related injuries and deaths in minority communities. In 1992, 52,000 U.S. residents had a traumatic brain injury that contributed to their deaths. Forty-four percent of those deaths were caused by firearms--the largest cause of trauma-associated death for Black and Hispanic males.[2] By the year 2003, firearm-related violence is expected to be the leading cause of trauma-related death and disability in the United States.[3] So Blacks and Hispanics will be disproportionately affected by the new regulations. Second, implementation of the new regulations will be difficult in minority populations because of the history of abuse of informed consent. African Americans have historically been subjects of medical experiments without their consent, without benefit to themselves, and often without benefit to science. Many people will wonder what's different about this latest abrogation of informed consent. Is this yet another opportunity to force African Americans to be guinea pigs for white science? Although the Tuskegee experiment is the emblem of experimentation without consent and the source of much African American suspicion of medical science, there are other examples where the principle of informed consent was ignored: research on slave women for finding a cure for urine leakage into the vagina; testing smallpox vaccine on slaves; perfection of the cesarean section on black women. …

How well does midwifery education prepare for clinical practice? Exploring the views of Swedish students, midwives and obstetricians

Backgroundmidwifery education in many countries has been adapted to the academic system by a stronger focus on research methodology and scientific evidence. This development has often taken place without extending the programs. We were interested in exploring views about current content of midwifery education in Sweden with a focus on clinical competencies and the new research components. Objectiveto investigate views about Swedish midwifery education held by students prior to graduation and after 1 year of practice, and by experienced midwives and obstetricians, with special focus on clinical competency. Designnationwide surveys conducted between June 2007 and January 2008, and 1 year later (follow-up of students). Methodsself-administered questionnaires completed by 171 (83%) students and 121 (59%) of these participants after 1 year of midwifery practice, and by 162 (54%) midwives and 108 (40%) obstetricians with at least 5 years of clinical experience. The responders were asked to assess predefined intrapartum competencies, which components of the education were allocated too little and too much time, and how well the education prepared for clinical practise overall. Content analysis of open-ended questions and descriptive analyses was used. Findingsmost students, midwives and obstetricians were ‘very’ or ‘fairly’ satisfied with how the education prepared midwives for clinical practice and 1.8%, 4.7% and 17.6%, respectively, were dissatisfied. About half of the obstetricians and one-third of the experienced midwives rated new midwives' ability to identify deviations from normal progress as low or lacking, compared with 10% of the students. A majority found that too little time, of the 60 weeks programme, was allocated to intrapartum care and medical complications and too much time to research and writing a minor thesis. Key conclusionsalthough few were dissatisfied with how midwifery education prepared for clinical practice in general, the majority of participants would have liked more time for medical complications, intrapartum care, and emergency situations, and less for research. These findings suggest that the balance between clinical competency and research, and how the research component is integrated into clinical knowledge, should be further discussed and evaluated. Also the discrepancy between the views of newly educated midwives and those of more experienced midwives and obstetricians need further investigation.

The Value of Desmethylclozapine and Serum CRP in Clozapine Toxicity: A Case Report

Clozapine, an atypical antipsychotic, has proved to be superior to other antipsychotics in treating patients with refractory schizophrenia. An increased plasma clozapine level above the therapeutic window may be associated with serious adverse events including paralytic ileus. Clozapine toxicity may occur in association with infection or after drug overdose. In a medical emergency situation, differentiating between a toxic clozapine ingestion and an infection-induced toxicity might be hindered by associated CNS changes and by the clozapine modulation of the inflammatory process. This may delay prompt initiation of a tailored treatment strategy. Here, we report a case of paralytic ileus developed within the context of clozapine toxicity. Although the underlying cause of toxicity was not clinically obvious, giving antimicrobial therapy resulted in an improvement in the patient's clinical condition. This report indicates the value of serum levels of C-reactive protein and desmethylclozapine, major metabolite of clozapine, in the treatment of aetiologically unclear clozapine toxicity.

Social Credential-Based Role Recommendation and Patient Privacy Control in Medical Emergency

Emerging Health Information Technologies (HIT), such as Electronic Health Records (EHR) and Personal Health Records (PHR) systems, facilitate access to and sharing of patients’ medical data in a distributed environment. The privacy protection of medical information is a pressing issue with the use of these medical technologies. In this paper, the authors present a Patient-controlled Privacy Protection Framework, which allows a patient to specify his or her own privacy policies on their own medical data no matter where they are stored. In addition, the authors extend this basic framework to medical emergency situations, where roles and users may not be limited to an organizational boundary. To enforce patient’s privacy policies even in emergency situations, the authors propose the Situation Role-based Privacy Control model and a social network-based user credential discovery method to recommend a situation role to candidate users. The authors present a mobile prototype system and two experiments to show the feasibility of our approach.

Medical Emergencies In Psychiatric Hospitals

Patients with co-existing medical and psychiatric diagnoses can be challenging to assess, evaluate, and treat. Medical emergencies among psychiatric patients may receive delayed medical responses or remain undetected if medical emergency training and response are not in place, leading to negative patient outcomes, including death. The role of the psychiatric nurse is pivotal in recognizing and responding to acute medical complications in the inpatient psychiatric population. However, little research exists concerning the educational needs of psychiatric nurses on medical emergency situations or on the use of medical emergency treatment in psychiatric facilities. Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center in Pennsylvania has recently launched specific guidelines and educational in-services for nurses and other health care professionals to utilize in determining the need for emergency medical treatment. Current data indicate these guidelines, that have psychiatric nurses playing an integral role, to be effective in improving patient outcomes in medical emergency situations. The purpose of this paper is to demonstrate the need for medical emergency strategies in psychiatric facilities and to stress the important role that psychiatric nurses play in determining the success of implemented medical emergency response strategies.

Guión bilingüe en urgencias de atención primaria

English language skills are growing fast among the world's population, and especially in Europe. Health professionals cannot and should not be excluded from this group, as achieving fluent and effective communication with foreign patients is a basic skill in our profession. The basic purpose of this paper is to provide a simple bilingual script that may help to prepare a medical record in emergency medical situations in rural areas. The knowledge of English for any professional in the area of Health is an obvious need in a world where the language of communication is English. The bilingual script contributes to the achievement of an initial syndromic diagnoses in the urgent care of a foreign patient, and with this script, we make it easier to register the foreign patients treated in our health area.

Misinterpretation of Pneumoperitoneum in Thoracoabdominal Injuries: Report of Two Cases

Colon perforation caused by blunt abdominal trauma is rare and the correct early diagnosis of this condition may be difficult. However, a delayed diagnosis may prove serious, and early repair of the perforation is critical. We report two cases of colon perforation caused by abdominal blunt contusion with combined thoracic injury. Due to the rarity of and the unfamiliarity with such injury, surgeons misinterpreted the finding in computed tomography scans as abdominal air coming from the thoracic injury and the diagnoses were difficult in both cases. In one patient the condition was discovered in time, and the perforation was properly repaired, while a delay in the other resulted in sepsis with permanent brain damage. Perforation of the colon is sometimes difficult to diagnose in emergency medical care situations, especially in multiple-trauma patients. Nevertheless, any suspicion of pneumoperitoneum should be cautiously investigated and physicians should not only depend on the image diagnosis but also consider further invasive procedures such as laparoscopy or diagnostic peritoneal lavage to exclude possible hollow viscus injury.

Focus-assessed transthoracic echocardiography in the sitting position: two life-saving cases

Focus-Assessed Transthoracic Echocardiography (FATE) is a point-of-care ultrasound protocol allowing the fast evaluation of the cardio-pulmonary status. It has been well established that patients with an exacerbation of chronic obstructive lung disease and lung oedema benefit from the sitting position. These and other medical emergency situations may prevent patients from attaining the supine position, thus precluding standard echocardiography. Portable ultrasound machines with a wide range of different probes are now available at limited costs. This allows the physician to bring point-of-care ultrasound to the patient in almost any location. We present two cases of severely ill patients where FATE was performed in the sitting position with decisive impact on subsequent therapy.

Exertional Heat Stroke and Emergency Issues in High School Sport

Every year, recreational, high school, collegiate, and professional athletes die as a direct result from sport participation (7). The primary causes include cardiac arrest, head injuries, exertional sickling, asthma, and exertional heat stroke (EHS) (7). A recent article published in the NATA News (3) highlights the sudden deaths of young athletes, where in 2008 alone, they recount 12 high school football players died, along with 2 youth-leaguer football players and 2 soccer athletes (3,7). Although there are many causes of sudden death in sports, schools with sanctioned athletic events need to be prepared to prevent, assess, and treat these medical emergencies. The most appropriate individual to manage a medical emergency situation on a daily basis at the high school level is a certified athletic trainer. Certified athletic trainers (ATs) are allied health care professionals specially trained in the prevention, recognition, treatment, and rehabilitation of athletic injuries within the physically active. The National Athletic Trainer’s Association (NATA) encourages all secondary schools to have a comprehensive athletic health care system in place, which includes having a school physician and an on-site AT to provide appropriate medical care. Secondary schools that fail to implement the recommendations made by the NATA regarding appropriate medical care for the secondary-aged athlete places the medical care into the hands of an untrained individual and implementation of the school’s emergency action plan (EAP) ultimately becomes the responsibility of the athletic director, strength and conditioning staff, and coaching staff. The EAP is a document that outlines the care an athlete should receive when a medical emergency arises and should include all personnel involved in the care of the injured athlete and include a discussion of all the potential causes of sudden death. Despite having an EAP in place, secondary schools without appropriate medical care providers on-site are at risk for common errors, such as delay in care, misdiagnosis, and improper treatment, which can lead to death, as was seen with the high-profile tragic death of Kentucky High School football player Max Gilpin in August 2008.

Crise de tétanie

Background: Medical emergencies in dental offices are considered a problem in most countries owing to dentists’ concerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medical emergencies in dental offices and dentists’ preparedness have been analysed in several countries but have never been studied in Poland. Aim: To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists’ preparedness and attitudes towards medical emergencies. Methods: An 18-item questionnaire was completed by 419 dentists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equipment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard deviation. Pearson’s linear correlation coefficient was used to determine correlation strength. Results: The most common medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5–10 for 0.48% and more than 10 for 0%. As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing seizures. Conclusion: The prevalence of medical emergencies in dental offices in Poland is comparable with that in other countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergraduate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency medical equipment in the dental office.

Intraosseous Devices: A Randomized Controlled Trial Comparing Three Intraosseous Devices

Introduction. Access to the circulation is mandatory for adequate treatment in medical emergency situations. Intraosseous (IO) infusion is a safe, fast, and effective alternative for gaining access to the circulation, if intravenous access fails. In the last decade, the IO method gained renewed interest. New devices have been developed, such as the Bone Injection Gun (BIG) 15G/18G and the First Access for Shock and Trauma 1 (FAST1). Objective. To determine which IO needle is preferable for gaining IO access in patients requiring acute administration of fluids or medication in a prehospital setting. Methods. In this single-blind prospective randomized trial, the IO needles were added to the equipment of the helicopter emergency medical services (HEMS) system. The HEMS nurses received training in proper use of all needles. Children (1–13 years) were randomized to the Jamshidi 15G or the BIG 18G, and adults (≥ 14 years) were randomized to the Jamshidi 15G, the BIG 15G, or the FAST1. All patients requiring acute administration of fluids or medication, without successful insertion of an intravenous (IV) catheter, were included. The IO needles were compared in terms of insertion time, success rate, bone marrow aspiration, adverse events during placement, and user satisfaction. Results. Sixty-five adult and 22 pediatric patients were included. The treatment groups were similar with respect to age, gender, mortality, and trauma mechanism (p ≥ 0.05). The median insertion times ranged from 38 seconds for the Jamshidi 15G to 49 seconds for the BIG 15G and 62 seconds for the FAST1 (p = 0.004). The devices did not differ with respect to success rates (adults overall 80% and children overall 86%), complication rates, and user satisfaction. Conclusions. The Jamshidi 15G needle could be placed significantly faster than the FAST1. The devices had similar success rates, complication rates, and user-friendliness. Intraosseous devices provide a safe, simple, and fast method for gaining access to the circulation in emergency situations.

Kreislauf- und Volumentherapie beim Kind

Volume depletion in children is a common finding in emergency medical service situations. Not only intestinal diseases and fever but also respiratory problems and pain can result in a relevant dehydration in paediatric patients due to their high water requirements.Children are endangered most by under diagnosing a compensated shock state. Compensatory mechanisms are able to maintain consciousness and normal systolic blood pressure until cardiopulmonary failure and arrest. High flow oxygen delivery and immediate fluid resuscitation are paramount. If a peripheral venous access cannot be established within a limited time, intraosseous infusion is mandatory. Isotonic crystalloid solutions are currently still the preferred initial fluids for volume replacement in children. Initial treatment is based on repetitive volume boluses of 20 ml/kg body weight over 5 to 20 min until clinical signs start to improve.Special clinical conditions, such as metabolic derangements, sepsis or burns may require a differentiated approach and subspecialty consultation.

103: Is There a Doctor in the House? The Experience of Medical Students as Responders to Out-of-Hospital Emergency Medical Situations

103: Is There a Doctor in the House? The Experience of Medical Students as Responders to Out-of-Hospital Emergency Medical Situations