Resuscitation Treatment Research Articles

Dependent contrast layering sign on CT in patients irrespective of cardiac dysfunction and its clinical implications: A preliminary retrospective study

Purpose: CT findings of contrast layering in dependent areas of the central venous system and solid organs have been reported in the literature to be associated with imminent cardiac arrest. However, no systematic research has explored the association of this distinctive CT finding with cardiac arrest and mortality. Therefore, we investigated the radiological manifestations of dependent layering of contrast in various vascular structures and organs and its clinical implications. Methods: A computerized search of radiological database was conducted using keywords “layering contrast” between January 2008 and January 2022. After reviewing CT scans of 226 patients that met the keyword criteria, 21 patients who exhibited the dependent contrast layering sign (DCLS) in vascular structures and organs were included in the final study population. Clinical data such as cardiac arrest within 2 hours, in-hospital mortality, and shock index ≥ 0.9 were collected. Number of involved structures in each patient is also investigated. Statistical significance and frequency regarding the association between radiologic findings and clinical data were analyzed. Results: The distribution of DCLS across anatomical structures reveals IVC is involved in 90.5% of patients and followed by hepatic vein (80.9%), liver parenchyma and right atrium. Cardiac arrest within 2 hours is significantly more common in patients with DCLS in right atrium (p=0.02, odds ratio = 21.6) and liver parenchyma (p=0.01, odds ratio = 24.8). DCLS in liver parenchyma is associated with the highest rate of in-hospital mortality (4 of 7, 57.1%). The total number of involved structures (p=0.01) and the number of common structures (p=0.001) are significantly higher in patients with cardiac arrest within 2 hours. Conclusions: The presence of DCLS in the right atrium and liver, as well as the larger number of involved structures, are significantly associated with impending cardiac arrest. Thus, it may offer additional insights for both radiologists and clinicians and aid in prompt initiation of resuscitative interventions before the onset of cardiac arrest. Nevertheless, larger prospective studies are warranted to validate the clinical relevance of DCLS across various vascular structures and organs.

Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India.

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

A trauma expert consensus: Capabilities are required early to improve survivability from traumatic injury.

Mortality reviews examine US military fatalities resulting from traumatic injuries during combat operations. These reviews are essential to the evolution of the military trauma system to improve individual, unit, and system-level trauma care delivery and inform trauma system protocols and guidelines. This study identifies specific prehospital and hospital interventions with the potential to provide survival benefits. US Special Operations Command fatalities with battle injuries deemed potentially survivable (2001-2021) were extracted from previous mortality reviews. A military trauma review panel consisting of trauma surgeons, forensic pathologists, and prehospital and emergency medicine specialists conducted a methodical review to identify prehospital, hospital, and resuscitation interventions (e.g., laparotomy, blood transfusion) with the potential to have provided a survival benefit. Of 388 US Special Operations Command battle-injured fatalities, 100 were deemed potentially survivable. Of these (median age, 29 years; all male), 76.0% were injured in Afghanistan, and 75% died prehospital. Gunshot wounds were in 62.0%, followed by blast injury (37%), and blunt force injury (1.0%). Most had a Maximum Abbreviated Injury Scale severity classified as 4 (severe) (55.0%) and 5 (critical) (41.0%). The panel recommended 433 interventions (prehospital, 188; hospital, 315). The most recommended prehospital intervention was blood transfusion (95%), followed by finger/tube thoracostomy (47%). The most common hospital recommendations were thoracotomy and definitive vascular repair. Whole blood transfusion was assessed for each fatality: 74% would have required ≥10 U of blood, 20% would have required 5 to 10 U, 1% would have required 1 to 4 U, and 5% would not have required blood products to impact survival. Five may have benefited from a prehospital laparotomy. This study systematically identified capabilities needed to provide a survival benefit and examined interventions needed to inform trauma system efforts along the continuum of care. The determination was that blood transfusion and massive transfusion shortly after traumatic injury would impact survival the most. Expert Opinion; Level V.

Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis

BackgroundThe outcomes of several randomized trials on extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out-of-hospital cardiac arrest were examined using frequentist methods, resulting in a dichotomous interpretation of results based on p-values rather than in the probability of clinically relevant treatment effects. To determine such a probability of a clinically relevant ECPR-based treatment effect on neurological outcomes, the authors of these trials performed a Bayesian meta-analysis of the totality of randomized ECPR evidence.MethodsA systematic search was applied to three electronic databases. Randomized trials that compared ECPR-based treatment with conventional CPR for refractory out-of-hospital cardiac arrest were included. The study was preregistered in INPLASY (INPLASY2023120060). The primary Bayesian hierarchical meta-analysis estimated the difference in 6-month neurologically favorable survival in patients with all rhythms, and a secondary analysis assessed this difference in patients with shockable rhythms (Bayesian hierarchical random-effects model). Primary Bayesian analyses were performed under vague priors. Outcomes were formulated as estimated median relative risks, mean absolute risk differences, and numbers needed to treat with corresponding 95% credible intervals (CrIs). The posterior probabilities of various clinically relevant absolute risk difference thresholds were estimated.ResultsThree randomized trials were included in the analysis (ECPR, n = 209 patients; conventional CPR, n = 211 patients). The estimated median relative risk of ECPR for 6-month neurologically favorable survival was 1.47 (95%CrI 0.73–3.32) with a mean absolute risk difference of 8.7% (− 5.0; 42.7%) in patients with all rhythms, and the median relative risk was 1.54 (95%CrI 0.79–3.71) with a mean absolute risk difference of 10.8% (95%CrI − 4.2; 73.9%) in patients with shockable rhythms. The posterior probabilities of an absolute risk difference > 0% and > 5% were 91.0% and 71.1% in patients with all rhythms and 92.4% and 75.8% in patients with shockable rhythms, respectively.ConclusionThe current Bayesian meta-analysis found a 71.1% and 75.8% posterior probability of a clinically relevant ECPR-based treatment effect on 6-month neurologically favorable survival in patients with all rhythms and shockable rhythms. These results must be interpreted within the context of the reported credible intervals and varying designs of the randomized trials.RegistrationINPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060).

At the threshold of viability: to resuscitate or not to resuscitate – the perspectives of Israeli neonatologists

ObjectiveThis study aims to examine the perspectives of neonatologists in Israel regarding resuscitation of preterm infants born at 22–24 weeks gestation and their consideration of parental preferences. The factors that...

A Survey of Umbilical Cord Clamping Practices and Attitudes of Canadian Maternity Care Providers

Despite mounting evidence of the health benefits of delayed cord clamping of term and preterm neonates, Canadian practice guidelines about the optimal timing of cord clamping have not been developed. At the time the study was conducted, the Society of Obstetricians & Gynecologists of Canada (SOGC) recommended early clamping as part of active management, while findings from several randomized controlled trials pointed at reported benefits of delayed cord clamping. It is unclear how Canadian maternity care providers were interpreting the evidence around umbilical cord clamping and what they do in clinical practice. A link to an online survey was distributed to members of the Canadian Association of Midwives (CAM) and the SOGC to assess maternity care providers’ umbilical cord clamping practices and attitudes. Respondents were asked to answer questions pertaining to the timing of cord clamping, reasons for cord clamping practices and perceived benefits and risks associated with delayed cord clamping (> 60 seconds) for 1) term and 2) preterm infants (< 37 weeks). A total of 353 respondents met eligibility criteria (i.e. they provided intrapartum care at the time of data collection). The majority of obstetricians (77.9%) reported clamping the cord of term infants immediately (< 30 seconds), compared to 60.0% of family physicians and 9.8% of midwives; 6.5% of obstetricians, 9.1% of family physicians and 65.7% of midwives reported delaying cord clamping by two minutes or more. Midwives were more likely than physicians to make a conscious decision about the timing of cord clamping. Care providers reported higher rates of immediate cord clamping with preterm infants, compared to term infants, with 85% of physicians and 39% of midwives clamping the cord of preterm neonates within 30 seconds. The most common reason for clamping the cord of a term neonate immediately was the infants’ need for resuscitation or other medical interventions (79%). Personal routine was the most frequently cited reason for clamping the cord of a preterm infant immediately (40%). Findings from this survey highlight interprofessional variations in cord clamping practices. Clear practice guidelines around the optimal timing of cord clamping should be developed that take into considerations the health benefits of delaying cord clamping of term and preterm infants.

Massive Pericardial Bleeding Following Cardiopulmonary Resuscitation and Percutaneous Coronary Intervention: A Case Report and Review of Literature.

Massive Pericardial Bleeding Following Cardiopulmonary Resuscitation and Percutaneous Coronary Intervention: A Case Report and Review of Literature.

Resuscitative Thoracotomy for Penetrating Trauma, a Valid Option in the Right Circumstances

Abstract The need to perform a clamshell thoracotomy in the emergency department for thoracic injuries is infrequent. The rates of survival after emergency thoracotomy are considerably low, with penetrating trauma cases exhibiting survival rates of 9% to 12%, and blunt trauma cases observing survival rates of 1% to 2%. We present an atypical instance of survival following resuscitative thoracotomy performed in the emergency department. The procedure was undertaken on a 30-year-old male victim of gunshot wounds to the chest and abdomen. On arrival to emergency department, the patient had a traumatic cardiac arrest. A resuscitative thoracotomy was carried out, restoring a spontaneous heart rhythm before transferring the patient to the operating room. A midline exploratory laparotomy was performed for abdominal injuries. Remarkably, the patient survived the procedure and fully recovered. This case serves as an illustration of how clamshell thoracotomy can be an effective resuscitative lifesaving intervention for penetrating thoracic trauma when accompanied by the appropriate setup.

Cardiac Arrest in Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant global health concern with substantial contributions to illness and mortality rates. This study aims to scrutinize the intricate interplay between neurological and circulatory abnormalities post-TBI, particularly focusing on the challenge posed by cardiac arrest in TBI patients. The study employs a comprehensive approach, utilizing clinical assessments, electrocardiograms, intracranial pressure monitoring, brain imaging, and biomarker utilization. It explores the effectiveness of these methods in detecting cardiac arrest in TBI patients. Additionally, the research delves into resuscitation techniques, hemodynamic stabilization, intracranial pressure management, and neurological enhancement as potential therapeutic modalities. The results highlight the importance of prompt initiation of cardiopulmonary resuscitation and adherence to advanced cardiac life support protocols in TBI patients with cardiac arrest. Prognostic factors such as injury severity, response time, effectiveness of resuscitation interventions, and pre-existing medical conditions are identified as crucial elements in predicting cardiac arrest outcomes in TBI patients. The study concludes by emphasizing the critical necessity of a comprehensive approach to understand and manage the complex relationship between cardiac arrest and TBI. Incorporating scientific discoveries, clinical perspectives, and technological advancements, the review underscores the importance of addressing this multifaceted medical challenge through a thorough analysis and effective management strategies.

Intractable cough and hiccups after resuscitation and acute coronary syndrome treatment successfully treated using the Kampo medicine bukuyoingohangekobokuto: A case report

BackgroundEven in patients who survive resuscitation through multidisciplinary treatment, minor persistent symptoms can make hospital discharge difficult. Herein, we report a case of myocardial infarction with intractable symptoms following resuscitation, which were successfully treated using Kampo medicine. Case presentationA 71-year-old man experienced intractable cough and hiccups following resuscitation for acute myocardial infarction. Despite successful invasive treatment for his cardiac condition, the patient's persistent symptoms hindered his recovery and discharge from hospital. The patient was diagnosed with qi and blood deficiency, qi stagnation, and fluid retention, before being prescribed the Kampo medicine “bukuryoingohangekobokuto (BRIHK)”. Within days of treatment initiation, his symptoms notably improved, allowing him to be discharged. ConclusionThis case highlights the potential of Kampo medicine for addressing post-resuscitation symptoms that are refractory to conventional treatments, and emphasizes the importance of integrating Kampo medicine with Western medical practices to enhance patient care and quality of life.

Newborn resuscitation timelines: Accurately capturing treatment in the delivery room

ObjectivesTo evaluate the use of newborn resuscitation timelines to assess the incidence, sequence, timing, duration of and response to resuscitative interventions. MethodsA population–based observational study conducted June 2019–November 2021 at Stavanger University Hospital, Norway. Parents consented to participation antenatally. Newborns ≥28 weeks’ gestation receiving positive pressure ventilation (PPV) at birth were enrolled. Time of birth was registered. Dry-electrode electrocardiogram was applied as soon as possible after birth and used to measure heart rate continuously during resuscitation. Newborn resuscitation timelines were generated from analysis of video recordings. ResultsOf 7466 newborns ≥28 weeks’ gestation, 289 (3.9%) received PPV. Of these, 182 had the resuscitation captured on video, and were included. Two-thirds were apnoeic, and one-third were breathing ineffectively at the commencement of PPV. PPV was started at median (quartiles) 72 (44, 141) seconds after birth and continued for 135 (68, 236) seconds. The ventilation fraction, defined as the proportion of time from first to last inflation during which PPV was provided, was 85%. Interruption in ventilation was most frequently caused by mask repositioning and auscultation. Suctioning was performed in 35% of newborns, in 95% of cases after the initiation of PPV. PPV was commenced within 60 s of birth in 49% of apnoeic and 12% of ineffectively breathing newborns, respectively. ConclusionsNewborn resuscitation timelines can graphically present accurate, time-sensitive and complex data from resuscitations synchronised in time. Timelines can be used to enhance understanding of resuscitation events in data-guided quality improvement initiatives.

Impact of Updating the Cardiopulmonary Resuscitation Guidelines on Out-of-Hospital Shockable Cardiac Arrest: A Population-Based Cohort Study in Japan.

International consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science and treatment recommendations (CoSTR) have reported updates on CPR maneuvers every 5 years since 2000. However, few national population-based studies have investigated the comprehensive effectiveness of those updates for out-of-hospital cardiac arrest due to shockable rhythms. The primary objective of the present study was to determine whether CPR based on CoSTR 2005 or 2010 was associated with improved outcomes in Japan, as compared with CPR based on Guidelines 2000. From the All-Japan Utstein Registry between 2005 and 2015, we included 73 578 adults who had shockable out-of-hospital cardiac arrest witnessed by bystanders or emergency medical service responders. The study outcomes over an 11-year period were compared between 2005 of the Guidelines 2000 era, from 2006 to 2010 of the CoSTR 2005 era, and from 2011 to 2015 of the CoSTR 2010 era. In the bystander-witnessed group, the adjusted odds ratios for favorable neurological outcomes at 30 days after out-of-hospital cardiac arrest by enrollment year increased year by year (1.19 in 2006, and 3.01 in 2015). Similar results were seen in the emergency medical service responder-witnessed group and several subgroups. Compared with CPR maneuvers for shockable out-of-hospital cardiac arrest recommended in the Guidelines 2000, CPR maneuver updates in CoSTR 2005 and 2010 were associated with improved neurologically intact survival year by year in Japan. Increased public awareness and greater dissemination of basic life support may be responsible for the observed improvement in outcomes. URL: https://www.umin.ac.jp/ctr/; Unique identifier: 000009918.

Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis

ObjectiveAn emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes.MethodThis was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured.ResultsOf the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed.ConclusionCompared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.

Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center.

Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital mortality. Results: 8624 trauma admissions and 677 trauma-related deaths occurred (47.7% at the scene and 52.3% in-hospital). Among in-hospital mortality, the majority were males, with a mean age of 35.8 ± 17.2 years. Most deaths occurred within 3-7 days (35%), followed by 33% after 1 week, 20% on the first day, and 12% on the second day of admission. Patients with early mortality were more likely to have a lower Glasgow coma scale, a higher shock index, a higher chest and abdominal abbreviated injury score, and frequently required exploratory laparotomy and massive blood transfusion (P < .005). The injury severity scores and proportions of head injuries were higher in the late mortality group than in the early group. The severity of injuries, blood transfusion, in-hospital complications, and length of intensive care unit stay were comparable among the age groups, whereas mortality was higher in the age group of 19 to 44. The higher proportions of early and late in-hospital deaths were evident in the age group of 24 to 29. In multivariate analysis, the shock index (OR 2.26; 95%CI 1.04-4.925; P = .04) was an independent predictor of early death, whereas head injury was a predictor of late death (OR 4.54; 95%CI 1.92-11.11; P = .001). Conclusion: One-third of trauma-related mortalities occur early after injury. The initial shock index appears to be a reliable hemodynamic indicator for predicting early mortality. Therefore, timely hemostatic resuscitation and appropriate interventions for bleeding control may prevent early mortality.

Fournier's gangrene: a review of predictive scoring systems and practical guide for patient management.

This article aims to provide a practical guide for patient management and an overview of the predictive scorings for Fournier's gangrene (FG) that are available to aid clinicians. A literature was performed reviewing currently used scoring systems for FG and presenting a practical guide for its management based on the available evidence. There are four specific scoring systems available for the assessment of FG although few other non-specific and generic tools also exist. These specific tools include Laboratory Risk Indicator for Necrotizing Fasciitis, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and Simplified Fournier's Gangrene Severity Index and help calculate expected mortality. Our proposed algorithm covers primary assessment, resuscitative interventions, initial investigations, urgent care, post-operative care, and long-term follow-up. The management of the FG patient can be divided into initial resuscitation, surgical debridement, ongoing ward management with antibiotic therapy, wound reconstruction, and long-term follow-up. Each facet of care is vital and requires multidisciplinary team expertise for optimal outcomes. Whilst mortality continues to improve, it remains significant, reflecting the severe and life-threatening nature of FG. More research is certainly needed into how this care is individualised, and to ensure that long-term outcomes in FG include quality of life measures after discharge.

Characteristics and outcomes of cardiac arrest patients with prolonged resuscitation

Background: There is lack of uniformity and consensus amongst the emergency physicians about an appropriate duration of cardiopulmonary resuscitation (CPR) and resuscitative efforts before deciding about termination of resuscitation (TOR) in patients with either out-of-hospital or in the emergency department (ED) non-traumatic cardiac arrests. An ideal duration of resuscitation for those with persistent cardiac arrest has not been determined yet. This study aims to evaluate the resuscitative interventions, patient factors and outcomes associated with prolonged duration of resuscitation in these patients. Methods: A retrospective study conducted in the Emergency Department (ED) of Changi General Hospital, Singapore and included 15 non-consecutive and randomly selected adult patients who either had an out-hospital cardiac arrest (OHCA) or suffered a witnessed cardiac arrest soon after arrival in the ED and were resuscitated further. Results: The median age was 58 years (IQR 51.5–70.5 years), and the median total CPR and resuscitation duration was 46 min (IQR 40–62.5 min). 12 patients sustained ROSC and one had transient ROSC. Ten (10) patients survived to hospital admission from ED and 5 of them underwent emergency angiography from ED. Three patients were discharged from hospital eventually with mRS scores of 0–1. Conclusion: Patients with sustained ROSC were older, had more prevalence of co-morbidities and lesser prevalence of shockable rhythms, received bystander CPR and pre-hospital adrenaline more frequently, had longer total duration of CPR and a larger proportion were administered intravenous calcium gluconate during ED resuscitation.

Assessing Reverse Shock Index as a Survival Predictor for Trauma Patients in Emergency Settings: A Retrospective Observational Study

ntroduction: Identifying trauma patients with shock is crucial, as early intervention and prompt treatment improve patient prognosis and survival. To address this, the ratio of Systolic Blood Pressure (SBP) and Heart Rate (HR), known as the Reverse Shock Index (RSI), is measured. Aim: To evaluate the effectiveness of RSI calculation in assessing prognosis. Materials and Methods: This was a retrospective observational study in which data were retrospectively collected on trauma patients treated in the Emergency Room (ER) at Dhiraj Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from January 2021 to December 2022. Patients involved in road traffic accidents, fall from a height of ≥6 m, assault, and machinery injuries were included. Upon arrival, vital signs such as HR, SBP, Respiratory Rate (RR), Glasgow Coma Scale (GCS), associated injuries, and in-hospital mortality were documented. Any resuscitative procedures required, such as Cardiopulmonary Resuscitation (CPR), intubation, oxygen therapy, chest tube insertion, and blood transfusion, were also recorded. The RSI was calculated for all trauma patients and divided into two groups (RSI &lt;1 and RSI ≥1). The t-test was performed with a 95% Confidence Interval (CI). Results: Out of 363 patients, data from 320 patients were included. Among them, 55 patients (17.2%) had RSI &lt;1, and 265 patients (82.8%) had RSI ≥1. Patients with RSI &lt;1 exhibited lower GCS scores, tachypnoea (RR &gt;29), or bradypnoea (RR &lt;10), along with higher mortality rates. These patients also required resuscitative interventions. Those with RSI &lt;1 experienced more head injuries, thoracic trauma, and maxillofacial injuries (p&lt;0.001). Conclusion: The RSI &lt;1 in trauma patients demonstrated significantly higher predictive accuracy for adverse outcomes, serving as a primary tool for early intervention and aggressive care in the ER.

Hypothermic temperature control after successful resuscitation of out-of-hospital cardiac arrest in adults : Statement from the resuscitation and postresuscitation treatment working groups of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN) and the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) and the Austrian Association

In Germany per year approximately 60,000 and in Austria 5,000 adult patients suffer from out-of-hospital cardiac arrest. Only 10-15% of these patients survive without neurological damage. For decades hypothermic temperature control has been a central component of post-resuscitation treatment, but is controversial due to recently published studies.

A 33-Year-Old Man Presented with Abdominal Pain and Vomiting Starting a Day Ago

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are expanding their role beyond the glucose-lowering effects to include reducing body weight and managing the risk of cardiovascular and renal diseases. Accordingly, the number of people with type 2 diabetes using these medications is rapidly increasing. To minimize the potential side effects and ensure safer use, it’s essential to time prescriptions correctly and educate patients thoroughly. Special caution is required when prescribing to patients with symptomatic and severe hyperglycemia who require insulin. Patients should be instructed to discontinue the medication immediately if they experience symptoms like abdominal pain, nausea, or vomiting. Moreover, if a patient taking SGLT-2 inhibitors is in poor general condition, diagnostic tests for euglycemic diabetic ketoacidosis should be performed, even if the blood glucose levels are not elevated. In such cases, prompt fluid resuscitation and intravenous insulin treatment should be initiated. Additionally, the risk of diabetic ketoacidosis may increase under acute stress conditions such as severe infections, trauma, or major surgery. Therefore, it may be necessary to discontinue SGLT-2 inhibitors and switch to other medications for blood glucose management in these situations.

Establishing outcome-driven vital signs ranges for children in the prehospital setting.

Vital signs are frequently used in pediatric prehospital assessments and guide protocol utilization. Common pediatric vital sign classification criteria identify >80% of children in the prehospital setting as having abnormal vital signs, though few receive lifesaving interventions (LSIs). We sought to identify data-driven thresholds for abnormal vital signs by evaluating their association with prehospital LSIs. We evaluated prehospital care records for children (<18 years) transported to the hospital during 2022 from a large, national repository of emergency medical services (EMS) patient encounters. Predictors of interest were heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), and pulse oximetry. HR, RR, and SBP were converted to Z-scores using age-based distributional models. Our outcome was potential LSIs, defined as performance of selected respiratory procedures, resuscitative interventions, or medication administrations. Using cut point analysis, we identified higher specificity (maximal specificity with a minimum of 25% sensitivity) and higher sensitivity (maximal sensitivity with a minimum of 25% specificity) ranges for each vital sign and evaluated measures of diagnostic accuracy. We included 987,515 children (median age 10 years, IQR 2-15 years). An LSI occurred in 4.3% (2.1% with respiratory procedures, 1.2% with resuscitative interventions, and 2.0% with medication administration). HR, RR, and SBP demonstrated a U-shaped association with LSIs. Specificities ranged from 84.1% to 93.7% for higher specificity criteria, with RR demonstrating the best performance (sensitivity 84.6%, specificity 27.0%). Sensitivities ranged from 62.3% to 84.4% for higher sensitivity criteria. Cut points for pediatric vital signs were associated with LSIs. Specific age-adjusted ranges can identify children at higher and lower risk for receipt of LSI. These ranges may be combined with other objective measures to improve the assessment of children in the prehospital setting, assist in optimizing protocol utilization, improve transport decision making, and guide destination selection.