Patients In Prehospital Setting Research Articles

Development and domestication of a clinical guideline for pharmacological pain management of trauma patients in prehospital setting

Introduction: Inadequate management of acute traumatic pain in the prehospital stage is a fact, which has many physical and mental adverse effects. No clinical guideline for the pain management of prehospital trauma patients in Iran has been published yet. Aims: This study aimed at development and domestication of a clinical guideline for pharmacological management of pain in prehospital trauma patients. Materials and Methods: A multistage evolutionary study method was used. First, a systematic review of articles, books, and guidelines for prehospital acute pain management with a comprehensive approach was carried out, then clinical guidelines with the most relevance to the topic were selected, and their quality was evaluated with AGREE tools. Finally, the initial guideline was developed based on the recommendations of the most comprehensive ones. The Delphi method and experts panel were used to summarize the information and finalize the clinical guidelines recommendations. Results: A total of 38 clinical guidelines and 150 related articles were found, of which five more comprehensive clinical guidelines and the most relevant topics were identified and reviewed. The recommendations that were agreed on by the Delphi stage were considered as the final recommendations, and others were reviewed again in the panel of experts by making the necessary changes. Finally, the domestic clinical guideline with 52 recommendations in three areas (general, assessment, and drug recommendations) was developed. Conclusions: Iran prehospital emergency organizations can use the recommendations of this clinical guideline to improve the quality of care, satisfaction, and protect patients' right.

Abstract 281: Is Cerebral Regional Oxygen Saturation (rSO 2 ) Useful as a Physiological Monitoring Tool During CPR in Pre-Hospital Settings? An Analysis of 72 Cases in Osaka, Japan

Introduction: Simplified monitoring system of regional cerebral oxygen saturation (rSO 2 ) is a non-invasive technology for cerebral perfusion, but continuous changes of cerebral rSO 2 values among OHCA patients in pre-hospital settings have been insufficiently investigated. Methods: We recently developed a portable rSO 2 monitoring system that is very small (170х100х50mm in size and 600g in weight) and can use in pre-hospital settings. The sensor pad is attached to the patient’s forehead by the emergency-medical-service (EMS) personnel, and it can monitor cerebral rSO 2 immediately and continuously during CPR, from June 2013 through May 2018 in Osaka City, Japan. Results: We collected continuous changes in cerebral rSO 2 values for 72 OHCA patients during CPR by EMS personnel. Sixty-six cases were measured rSO 2 before ROSC and 6 cases were measured after ROSC. According to the analyses of continuous changes in rSO 2 values of 66 cases, two patterns of changes in cerebral rSO 2 values were found as follows; Type 1: Increasing rSO 2 type (n=30). Measured rSO 2 increased gradually during CPR or after ROSC. Type 2: Not increasing rSO 2 type (n=36) Measured rSO 2 did not increase during CPR. And we found out two phenomena of changes in cerebral rSO 2 values were found as follows; Phenomenon 1: Dropping rSO 2 type (n=3). Measured rSO 2 dropped after confirmation of ROSC or before arrest, which suggests that the re-arrest or arrest occurred during monitoring. Phenomenon 2: Initially decreasing rSO 2 type (n=6). Measured rSO 2 decreased gradually despite performing CPR by EMS personnel, which suggests that short time has passed after arrest. Conclusion: We measured continuous changes in cerebral rSO 2 values among 72 patients with OHCA pre-hospital settings and found the 2 patterns and 2-specific phenomena regarding continuous changes in rSO 2 values. Furthermore, it is needed to collect many cases to establish resuscitation strategies for OHCA by using cerebral rSO 2 monitoring.

Safety and analgesia of inhaling a mixture of nitrous oxide and oxygen in prehospital patients with traumatic pain

Objective To evaluate the safety and analgesia efficacy of inhalation of a blended 50/50 mixture of nitrous oxide and oxygen for relieving pain in limb traumatized patients in pre-hospital setting. Methods A total of 106 traumatic patients treated with painkiller of nitrous oxide and oxygen mixture in pre-hospital setting admitted in the emergency department from October 2014 to April 2016 were enrolled. They were divided into control group (n=53, inhalation of oxygen) and treatment group (n =53, treated with inhalation of a mixture of 50% nitrous oxide and oxygen) according to the computer-generated list of random number. The same routine treatment was given to patients of both groups. Respiratory rate (RR), heart rate (HR), blood pressure (BP), pulse oxygen saturation of oximetry (SpO2) measured at different intervals during the entire course of inhalation and adverse effects were recorded. The degree of pain was evaluated with the visual analogue scale (VAS). Results There were no significant differences between control group and treatment group in RR, HR, BP, and SpO2 before and 5, 10, 15, 30, 45 min after inhalation. Compared with RR and HR before inhalation, RR and HR were significantly decreased 10, 15, 30, 45 min after inhalation ( P<0.05 or <0.01) in treatment group. The RR was decreased 15, 30, 45 min after inhalation (P<0.05 or <0.01), but there was no statistically significant change in HR in control group. There were no differences in the VAS scores before inhalation between two groups (P=0.678) but the difference after inhalation were statistically significant (P<0.01) . The VAS scores after inhalation for 15 min in treatment group lowered to below 3, in an average of (2.94±1.03)(P<0.01). The VAS scores in control group were slightly lowered to above than 6 at all intervals after inhalation. There were some minor side effects consisting of dizziness (28.3%), nausea (24.53%), vomiting (15.09%) and drowsiness (5.66%) without serious adverse consequence in treatment group. Conclusions A blended 50/50 mixture of nitrous oxide and oxygen seems to have obvious analgesic effects on traumatic patients in pre-hospital setting, with very low rate of side effects, and it can be widely used in clinical practice. Key words: Prehospital; Trauma; Inhalation; Nitrous oxide; Oxygen; Analgesia; Safety; Effectiveness

Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report.

Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC). In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards. 101 cases with the mean age of 56.7 ± 12.3 years (30-78) were audited (55.4% male). 61 (60.3%) patients had chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%), O2 therapy (32.8%), nitroglycerin administration (60.7%), and aspirin administration (52.5%) in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%), O2 therapy (75%), cardiac monitoring (25%), pupils examination (25%), bedside glucometery (50%), and assessing for naloxone administration (55%) in prehospital care of patients with LOC were fair to poor. There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting.

Antihypertensive Medication in Suspected Stroke Patients in Pre-Hospital Settings in United States (P02.197)

Objective: We performed this study to determine the frequency and patterns of use of parentral antihypertensive agents with EMS settings. Acute hypertensive response has been observed in a large percentage of stroke patients. Background Pre-hospital initiation of antihypertensive agents may be advantageous or deleterious in stroke patients. Design/Methods: We analyzed the data related to the EMS transport of 101,478 stroke patients from in the 2009 National Emergency Medical Services Information System (NEMSIS) Research Dataset, from 26 states in the US.From this dataset we identified medication codes, transport time, and the geographic nature of each EMS dispatch. The transport time and geographic nature of each call was considered relevant as the time of transport will impact EMS provider9s ability to initiate parenteral antihypertensive treatment and the ability of the treatment to have significant impact on the patient9s blood pressure (BP) prior to ED arrival. Results: We found 120 unique medication codes associated with these patients. Overall, 10 agents were administered to 1.9% (1,903/101,478) of the suspected stroke patients in the database. The number of times each agent (number of patients; frequency) was used as follows: Clonidine (1-.00%), Diltiazem (94 –4.9%), Enalapril (1-.00%), Hydralazine (1-.00%), Labatelol(219 – 11.5%),Metroprolol (80 – 4.2%), Nicardipine (14 - .7%), Nifedipine (1 - .00%), Nitroglycerin (1466 – 77%), and Nitroprusside (26 – 1.4%). The mean transport time was 15.7 minutes and the mean scene time was 17.2 minutes. The EMS dispatches occurred within four geographic groups with the following frequencies: rural (10.05%), suburban (10.22%), urban (77.03%), wilderness (2.70%). Conclusions: Although the use of antihypertensive medication in suspected stroked patients in the EMS setting is infrequent and not standardized, the mean scene and transport time provide a sufficient interval to allow for the initiation of IV antihypertensive medication in these patients. Disclosure: Dr. Anderson has nothing to disclose.

El acceso intraóseo para fluidoterapia en situación de combate. Experiencia de la sanidad militar española en Afganistán

ObjectivesTo describe the Spanish military medical staff’s experience with the use of intraosseous lines for fluid therapy in a combat zone. Patients and methodsDescriptive study of 25 patients (30 needles). The patients were injured by firearms or explosive devices, or had multiple injuries, and were attended by Spanish military physicians in western Afghanistan (Herat) between March 2007 and June 2008. ResultsThe bone puncture was performed on 19 patients in prehospital settings. The remaining 6 patients underwent the procedure in the Spanish military hospital. All patients were men; the mean (SD) age was 26 (2.3) years. Most belonged to the Afghan National Army (64%) and had injuries caused by explosive devices (68%). The largest percentage of injuries involved the lower limbs (56%). A line could be inserted in 76% of the cases (100% at the military hospital). The first-choice site of puncture was the anterior tibial tuberosity. Fluids and medications were successfully administered through the intraosseous lines. No complications occurred during needle insertion, but 5 patients reported pain. ConclusionOur experience suggests that intraosseous access can provide an alternative to venous access for treating trauma patients in combat zones.

Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial

Objectives To compare standard high flow oxygen treatment with titrated oxygen treatment for patients with an acute exacerbation of chronic obstructive pulmonary disease in the prehospital setting.Design Cluster randomised controlled...