Emergency Trauma Research Articles

Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit.

Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.

Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial.

BackgroundDecentralized health systems in low- and middle-income countries (LMICs) affected by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress caused by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and their feasible integration with artificial intelligence makes digital app interventions a promising pathway to promote precision diagnosis and high-impact care.ObjectiveThis study aimed to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining neural, cognitive, and biometric markers and the efficacy of the eResilience app, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity.MethodsTrauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience app with advanced monitoring capabilities was designed for this trial. Participants completed the eResilience app at home during a 7-day period. Clinical, cognitive, and electrophysiological data were collected at baseline, along with posttest measurements to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes, including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, well-being, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6, and 12 months after the intervention.ResultsData collection was conducted between 2018 and 2020. A total of 100 participants exposed to war were screened; 75 (75%) were enrolled and assigned to a trauma-exposed control (38/75, 51%) or posttraumatic stress disorder condition (37/75, 49%); and 70 (70%) completed all baseline, treatment, and posttest assessments. A total of 89% (62/70) of those who completed the intervention opted to enroll in the 3-, 6-, and 12-month follow-ups. Data collection is complete. As of May 2022, the results of all proposed analyses are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop artificial intelligence–powered, app-based diagnostic and prognostic features and determine the app’s cross-cultural efficacy for the treatment of trauma in emergency settings.ConclusionsThis protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and efficacy of the eResilience app across varied demographics, and a robust framework for investigating low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616001205426; https://tinyurl.com/yckwc4d7International Registered Report Identifier (IRRID)RR1-10.2196/38223

Comparison of Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for Prediction of Early Mortality in Adult Trauma Patients

Background: Trauma is an injury to living tissue from an external source. The severity of traumatic injuries plays a crucial role in the determination of mortality in patients with trauma, thus a proper understanding of the severity of trauma is very important for improving trauma care. Several scoring systems are available for the objective, initial assessment of the severity of injury to help treatment strategy. Aim of the study was to compare Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for prediction of early mortality in adult trauma patients. Methods: Study was conducted with 100 patients of either sex, age 18 years or above with history of trauma due to road accident, fall and assault. REMS and EMTRAS score was calculated from the laboratory and patient characteristics mentioned in the Trauma scoring datasheet, within 30 minutes of arrival of the patient in the hospital and 24 hours after hospitalization. Results: Comparison of the REMS score within 30 mins of patient arrival and at 24 hrs was statistically significant (p=0.0099). Comparison of EMTRAS SCORE Within 30 mins of patient arrival and at 24 hrs was not statistically significant (p=0.0505). Comparison of REMS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=<0.0001). Comparison of EMTRAS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=<0.0001). Comparison of AUROC (Area Under the Receiver Operating Characteristics) of REMS and EMTRAS were 0.689 and 0.789 respectively, which was statistically significant. Conclusion: We conclude that both REMS and EMTRAS are easy, accurate predictors of in-hospital early mortality in Adult Trauma Patients. But in our study, EMTRAS AUROC was greater than AUROC of REMS. Hence EMTRAS should have good prognostic power for predicting in-hospital early mortality in Adults Trauma patients.

Effect of Topical Sesame Oil on the Severity of Pain in Patients With Limb Trauma: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to investigate the effect of topical use of sesame oil on pain severity in patients with limb trauma. MethodsA placebo-controlled randomized controlled trial was conducted on 120 patients with nonpenetrating upper and lower limb traumas admitted to the trauma emergency department. The patients were allocated to either the sesame oil group or the placebo group using the stratified random sampling technique based on trauma size and age. Depending on the trauma area, sesame or placebo oil were poured on the trauma site and massaged for 5 to 7 minutes. The intervention was repeated twice a day for 3 days at home. Pain severity was measured using the numeric pain scale before intervention on the first day and 30 minutes after each intervention for 3 days, twice a day. Data were analyzed using descriptive and analytical tests including the independent t test, χ2 test, Fisher exact test, Mann-Whitney U test, Friedman test, and multiple linear regression analysis. The significance level was set at 0.05. ResultsThe decreasing trend of pain was significant in both the intervention and placebo groups (P < .001). Comparison of the trend of changes in pain scores between the 2 groups showed that the mean changes of pain severity were higher in the intervention group compared with the placebo group in all assessments. There was a significant difference in the rate of analgesic consumption in the intervention group compared with the placebo group (P < .001). However, there was no significant difference between the 2 groups regarding pain severity. Pain reduction was negatively associated with body mass index (b = –0.091, P = .003), amount of received pain medication (b = –0.001, P = .039), and area of trauma (b = –0.002, P = .039). Pain reduction was greater in male patients than female patients (b = 0.676, P = .015). The effect of sesame oil on pain changes was not significant. No adverse side effects were reported. ConclusionThis study showed that despite less use of analgesics in the intervention group than in the placebo group, sesame oil did not have any statistically significant effects on the severity of limb trauma pain. Further research is needed regarding the effect of topical sesame oil application on pain as a safe and uncomplicated intervention.

The true global burden of trauma: a call for a comprehensive trauma research platform

The true global burden of trauma: a call for a comprehensive trauma research platform

Interview With Brandy Mathews

BM: I began my nursing career as a staff nurse in the emergency department. For personal reasons, I left the university setting and returned to my hometown where I worked in the ICU and spent a couple of years as a flight nurse. Missing the academic medical center, I returned to the university and took my first non-direct patient care and supervisory position in a new department that was focused on throughput, capacity management, and organizational growth. I learned so much about managing people and processes during this time. I was also in a position to work with data, financial metrics, and capacity management strategies, which was an experience I was lacking from my clinical background. This prompted me to pursue an advanced degree with more of a business focus. From here, I became the department director, which led to the opportunity for my current role. Currently, I am a chief nursing officer of emergency services, trauma, surgical services, general and critical care medicine teams at both of our adult hospitals. I have been blessed to work with extremely talented people and to have supervisors and mentors who gave me opportunities but also pushed me to be my best! Roxane Spitzer, PhD, RN, MBA, MA, FAAN, is Editor Emeritus of Nurse Leader, in Madison Wisconsin, and a member of the board of directors of OnSomble. She can be reached at [email protected] .

The complexity of providing humanitarian surgical care in armed conflict: a framework to help categorize needs

Abstract Armed conflicts are increasing globally due to political unrest and the broader effects of climate change. Without resources to provide quality surgical care, it becomes nearly impossible to provide quality emergency surgery and trauma care similar to that in high-income countries. To understand and help aid organizations provide resources and address the surgical needs of populations facing armed conflict, a matrix to identify variables and help with interventions was envisioned. A previously published global surgery matrix based on the PIPES (Personnel, Infrastructure, Procedures, Equipment and Supplies) surgical capacity tool was adapted to this context. The novel matrix incorporates 108 variables. These variables are grossly divided into local and international agency components to address the issue of who is providing care. Using a time continuum of pre-conflict, conflict, and post-conflict allows organizations to concentrate on when during the conflict to target their intervention. In addition to the previously used personnel, infrastructure, procedures, equipment, and supplies categories, a sixth category called standards was included that addresses the issues such as information technology, data systems, quality improvement programs, and patient safety. Pilot testing of this matrix to obtain feedback from end users is the next step in development. Ultimately, peri-conflict preparedness should increase and improve surgical outcomes and reduce in death and disabilities around the world.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Abstract Since trauma is a growing health problem worldwide, emergency trauma care including emergency medical services (EMS) is becoming an integral part of the healthcare system. The optimal EMS which will improve access to trauma care, will be different in each country because of different healthcare systems, trauma etiology, and economic situations. To adopt models that have succeeded in developed countries is not always appropriate. In order to identify the optimal EMS model in developing countries, comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary. Therefore, this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries, and discusses the need to conduct more detailed and extensive comparisons.

Peningkatan Kesiapsiagaan Kader PKK Cibiru Wetan untuk Ketahanan Bencana di Masa Pandemi COVID-19

IMPROVİNG THE PREPAREDNESS OF CİBİRU WETAN PKK CADRES FOR DİSASTER RESİLİENCE DURİNG THE COVİD-19 PANDEMİC. Cibiru is a high-risk area for natural and man-made disasters, so efforts must be made to reduce the risk of disaster impacts. One effort that can be made is to strengthen the Cibiru Wetan village's resilience by increasing preparedness to deal with emergency cases caused by disasters, such as cases of respiratory arrest, cardiac arrest, trauma, and respiratory emergencies caused by COVID-19. Community service is performed to improve the preparedness of Cibiru Wetan PKK cadres for disaster-resilient village resilience during the COVID-19 Pandemic. The method of implementing community service by simulating basic life support, trauma event handling, prevention and handling of COVID-19 emergencies, and the production of health drinks made from natural ingredients such as ginger, honey, lime, cardamom, and turmeric to boost immunity. As a result, the Cibiru Wetan PKK cadres were able to simulate basic life support, first aid in the event of trauma, and respiratory disorders caused by COVID-19, as well as process natural ingredients into healthy drinks to increase immunity, thereby increasing the Cibiru Wetan village's resilience.

Evaluation of the Revised Trauma Score, MGAP, and GAP scoring systems in predicting mortality of adult trauma patients in a low-resource setting

BackgroundNumerous trauma scoring systems have been developed in an attempt to accurately and efficiently predict the prognosis of emergent trauma cases. However, it has been questioned as to whether the accuracy and pragmatism of such systems still hold in lower-resource settings that exist in many hospitals in lower- and middle-income countries (LMICs). In this study, it was hypothesized that the physiologically-based Revised Trauma Score (RTS), Mechanism/Glasgow Coma Scale/Age/Pressure (MGAP) score, and Glasgow Coma Scale/Age/Pressure (GAP) score would be effective at predicting mortality outcomes using clinical data at presentation in a representative LMIC hospital in Upper Egypt.MethodsThis was a retrospective analysis of the medical records of trauma patients at Beni-Suef University Hospital. Medical records of all trauma patients admitted to the hospital over the 8-month period from January to August 2016 were reviewed. For each case, the RTS, MGAP, and GAP scores were calculated using clinical data at presentation, and mortality prediction was correlated to the actual in-hospital outcome.ResultsThe Area Under the Receiver Operating Characteristic (AUROC) was calculated to be 0.879, 0.890, and 0.881 for the MGAP, GAP, and RTS respectively, with all three scores showing good discriminatory ability. With regards to prevalence-dependent statistics, all three scores demonstrated efficacy in ruling out mortality upon presentation with negative predictive values > 95%, while the MGAP score best captured the mortality subgroup with a sensitivity of 94%. Adjustment of cutoff scores showed a steep trade-off between optimizing the positive predictive values versus the sensitivities.ConclusionThe RTS, MGAP, and GAP all showed good discriminatory capabilities per AUROC. Given the relative simplicity and potentially added clinical benefit in capturing critically ill patients, the MGAP score should be further studied for stratifying risk of incoming trauma patients to the emergency department, allowing for more efficacious triage of patients in lower-resource healthcare settings.

Reliableness of Telegram between different evaluators in emergency general surgery practice

Background: 'Telegram' is a popularly used social media application in routine clinical practice, often for communication between a resident doctor and a consultant. The purpose of this study is to establish the reliableness of the data transmitted through telegram to validate its use in general surgery practice.Methods: Clinical findings and computerized tomographic (CT) images of 180 patients visiting the trauma center and emergency department were posted in a closed Telegram group involving three consultants (SSC, NBP, and LSB). The CT images were posted in the Telegram group as complete picture (CP) and picture of interest (POI) format and rated on a scale of 1-5. The consultants formulated a temporary diagnosis and initial management plan. The reliableness between different evaluators of these feedbacks was analyzed in our study.Results: Mean CP rating ranged from 3.03±0.61 to 3.73±0.64 [Cronbach alfa (α)-0.494, p=0.006]. Mean POI rating ranged from 3.4±0.56 to 4.13±0.73 (α-0.824, p&lt;0.0001). For diagnosis, the proportion of observed agreement (P0) was 83.3% for SSC and NP, 76.6% for SSC and LB, and 73.3% for NBP and LSB. For management, P0 was 86.6% for NBP and LSB, 86.6% for SSC and NBP, and 80% for SSC and LSB.Conclusions: Telegram messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with a fair reliableness between different evaluators.

Referral of District Level Operations to Regional Hospitals in South Africa

IntroductionIn South Africa, district hospitals have limited surgical capacity, and most surgical conditions are referred to higher-level facilities for definitive management. This study aims to identify the proportion, type, and volume of district-level general surgery referrals to two regional government hospitals in South Africa. Materials and methodsThis was a retrospective analysis of secondary data collected on persons who underwent general surgery operations at two South African regional hospitals between January 1, 2016 and December 31, 2018. District-level operations were those included in the South African Department of Health District Health Package. Descriptive analyses were performed to determine the proportions of district-level general surgery referrals and operations. Multivariate analyses were performed to determine factors associated with district-level general surgery operations. ResultsA total of 9357 persons underwent general surgery operations. Of these, 5925 (63.3%) were district-level operations. The most common district-level operations were lower limb amputations (n = 1007; 17.0%), abscess drainage (n = 936; 15.8 %), appendectomy (n = 791; 13.4%), non-trauma emergency laparotomy (n = 666; 11.2%), and inguinal hernia repair (n = 574; 9.7%). In multivariate analysis, district-level operations were associated with emergency conditions (OR: 5.64, P < 0.001), trauma (OR: 1.43, P < 0.001) and male gender (OR: 2.35, P < 0.001). ConclusionsIn South Africa, the majority of general surgery diseases treated at regional hospitals are district-level conditions. The definition of district-level conditions could be too broad, and a narrower basket of surgical care for district hospitals would focus training efforts on achievable targets. More resources are needed at regional hospitals to care for their additional surgical burden.

Changes in patterns of plastic surgery emergencies at a level I trauma center in India during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has had major effects worldwide, including sudden and forceful setbacks to the healthcare system. The COVID-19 pandemic has also led to changes in the plastic and reconstructive management of emergency cases, including those due to road traffic accidents. This study analyzed changes in patterns of plastic surgery emergencies and modifications in consultation policies to minimize the exposure of healthcare workers. Data on plastic surgery emergency calls received from the trauma and emergency department were collected for a period of 2 months before and during lockdown. The data were then analyzed with respect to the cause, mechanism, and site of the injury, as well as other variables. During lockdown, there was a 40.4% overall decrease in the plastic surgery emergency case volume (168 vs. 100). The average daily number of consultations before lockdown was 2.8 as compared to 1.6 during lockdown. Road traffic accidents remained the most common mechanism of injury in both groups (45.8% vs. 39.0%) but decreased in number during the lockdown (77 vs. 39). Household accidents, including burns, were the second most common cause of injury in both phases (7.7% vs. 20.0%), but their proportion increased significantly from 7.7.% to 20.0% in the lockdown phase (P=0.003). The percentage of minor procedures done in the emergency department increased from 53.5% to 72.0% during lockdown (P=0.002). Procedures in the operating room decreased by 73.1% during lockdown (67 vs. 18, P=0.001). The COVID-19 pandemic and lockdown orders in India greatly influenced trends in traumatic emergencies as observed by the plastic surgery team at our tertiary care center. Amidst all the chaos and limitations of the pandemic period, providing safe and prompt care to the patients presenting to the emergency room was our foremost priority.

Factors influencing first responders’ mental health during COVID-19

As the world adapts to the coronavirus-2019 (COVID-19) pandemic, healthcare professionals have been performing lifesaving medical interventions under intensely stressful conditions. First responders are a subset of this population that experience traumatic emergency situations daily while working in hazardous conditions during COVID-19. Past studies on first responders’ mental health have reported that post-traumatic stress disorder (PTSD) and suicidality are higher than anticipated in this population. In order to understand the factors influencing mental health in first responders during COVID-19, a survey was distributed to a convenience sample of 415 emergency responders from across the country. This survey addressed the influence of demographics and COVID-19 on cumulative PTSD and stress scores; 67 percent of survey respondents indicated that they knew another first responder who has contemplated or committed suicide, with 11 percent of respondents indicating that they themselves have suicidal tendencies. The results determined a variety of factors that influence mental health in first responders including age, gender, diagnosis of a previous mental health disorder, and career vs. volunteer departments. This study emphasizes the role that government funding plays in ensuring mental health resource access for first responders. Furthermore, this study has revealed that improved agency safeguards against COVID-19 can help reduce stress in emergency services personnel during this pandemic.

Organophosphorus Poisoning among Acute Poisoning Cases Presenting to the Emergency Department of a Secondary Care Centre: A Descriptive Cross-sectional Study.

Organophosphorus is an easily available compound, especially in agriculture and farming related areas. This study evaluated organophosphorus poisoning among the population in those high-risk areas. The main objective of this study is to find out the prevalence of organophosphorus poisoning among acute poisoning cases presenting to the Emergency Department of a secondary care centre. A descriptive cross-sectional study was conducted among 427 patients presenting to the Emergency Department in a secondary care centre from 17th July, 2018 to 14th January, 2022. Ethical clearance was taken from the Institutional Review Committee (Reference number: 01/2075-76). All the patients presenting to the Emergency Department were included and the patients without consent, patients with trauma, accident, severe illness and other emergency conditions were excluded. A convenience sampling was done. Data were collected and entered in Microsoft Excel version 2007 and analyzed using Statistical Package for the Social Science version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Out of 427 patients, 203 (47.54%) (42.80-52.28 at 95% Confidence Interval) had organophosphorus poisoning. It was most commonly seen in the age group 16-30 years among 103 (50.74%). The prevalence of organophosphorus poisoning in our study was similar when compared to other studies conducted in similar settings. Most of the organophosphorus poisoning cases were intentional and suicidal which is similar to other studies. acetaminophen; emergency departments; organophosphorus poisoning; prevalence.

Trends in Geriatric Trauma Emergency Department Admissions During COVID-19.

The impact of coronavirus disease-2019 (COVID-19) on geriatric trauma presenting to the emergency department is unknown. To examine geriatric trauma emergency department admission trends during the COVID-19 pandemic. This retrospective, observational, comparison study was conducted in an academic emergency department in Turkey. Trauma patients 65 years and older who presented to the emergency department within 1 year of March 12, 2020, were included. Patients admitted in the same date range in the previous year were included as the control group. The characteristics of the patients, injured area, and injury mechanisms were compared. Geriatric trauma admissions decreased (relative risk = 0.71, odds ratio [OR] = 0.69 [95% confidence interval, CI: 0.62, 0.77], p < .001). According to the type of injury, there was no significant difference in admissions to the emergency department (p = .318). During the pandemic, there was an increase in falls and a decrease in stab wounds and gunshot wounds (p = .001). Multiple trauma (OR = 5.56 [95% CI: 3.75, 8.23], p < .001), fall (OR = 2.41 [95% CI: 1.6, 3.73], p < .001), and-assault related injuries (OR = 4.43 [95% CI: 2.06, 9.56], p < .001) were determined as factors that increased the admissions to the emergency department compared with the prepandemic. Although geriatric trauma emergency department admissions decreased during the pandemic, those due to falls and assaults increased. Although curfews and social isolation resulted in a decrease in penetrating injuries, assault-related trauma has increased.

Efecto de la pandemia COVID en las urgencias traumatológicas pediátricas en tres zonas de España con distinta incidencia

Introduction and objectivesAlthough much has been published on the effect of the pandemic on trauma emergencies, it has not been analyzed whether the incidence of infection or different organization of available resources according to the Spanish region were influential factors. We present a multicenter study of three tertiary hospitals in three Spanish cities with different characteristics to study how these factors influenced pediatric trauma emergencies during the first wave of the pandemic. Material and methodsWe present a retrospective cohort study that compares and analyzes pediatric trauma emergencies in three different hospitals during the period of the first wave of the COVID-19 pandemic and we compare them with the same period of the previous year, analyzing the number of emergencies, the severity of the pathology, the average age of the patients, the days of admission and the waiting time of the cases that required surgical treatment. ResultsA total of 6,474 pediatric trauma emergency episodes have been analyzed. There was a drastic reduction in activity in the three hospitals, but in different amounts: 83.5% in the hospital located in Madrid, 75% in the hospital located in Valencia and 65.9% in the one located in Palma, Majorca. The emergencies attended were more serious in 2020 compared to 2019. The average age of patients treated during the pandemic was lower compared to the previous year. There were no differences in the days of admission, but there were differences in the delay in surgery for surgical fractures. ConclusionsThe impact of the first wave of the COVID-19 pandemic and the decreed confinement had a different impact on pediatric trauma emergencies in the different hospitals according to the incidence of infection and the measures adopted in the different regions. In all cases there was a significant reduction in activity, a greater proportion of medium and severe pathologies were attended to, the average age of the patients attended was lower and a delay was observed in surgeries performed in the emergency room, probably due to the need to request a PCR test to detect a COVID-19 infection.

Spectral Reflectance as a Unique Tissue Identifier in Healthy Humans and Inhalation Injury Subjects.

Tracheal intubation is the preferred method of airway management, a common emergency trauma medicine problem. Currently, methods for confirming tracheal tube placement are lacking, and we propose a novel technology, spectral reflectance, which may be incorporated into the tracheal tube for verification of placement. Previous work demonstrated a unique spectral profile in the trachea, which allowed differentiation from esophageal tissue in ex vivo swine, in vivo swine, and human cadavers. The goal of this study is to determine if spectral reflectance can differentiate between trachea and other airway tissues in living humans and whether the unique tracheal spectral profile persists in the presence of an inhalation injury. Reflectance spectra were captured using a custom fiber-optic probe from the buccal mucosa, posterior oropharynx, and trachea of healthy humans intubated for third molar extraction and from the trachea of patients admitted to a burn intensive care unit with and without inhalation injury. Using ratio comparisons, we found that the tracheal spectral profile was significantly different from buccal mucosa or posterior oropharynx, but the area under the curve values are not high enough to be used clinically. In addition, inhalation injury did not significantly alter the spectral reflectance of the trachea. Further studies are needed to determine the utility of this technology in a clinical setting and to develop an algorithm for tissue differentiation.

Implementation of an EMS protocol to improve prehospital sepsis recognition

PurposeOptimal sepsis outcomes are achieved when sepsis is recognized early. Recognizing sepsis in the prehospital, EMS setting can be challenging and unreliable. The purpose of this study is to evaluate whether implementation of an EMS sepsis screening and prehospital alert protocol called PRESS (PREhospital SepsiS) is associated with improved sepsis recognition by EMS providers. DesignWe conducted a 12-month, before-after implementation study of the PRESS protocol in a large, public EMS system. The study intervention was a PRESS training program delivered to EMS providers. EMS patient inclusion criteria included: age ≥ 18 years, EMS systolic blood pressure < 110 mmHg, EMS heart rate > 90 bpm, and EMS respiratory rate > 20 bpm. Study exclusion criteria included the presence of any of following EMS conditions: trauma, cardiac arrest, pregnancy, toxic ingestion, or psychiatric emergency. Retrospective chart review was performed on all eligible EMS encounters during the study period. The primary outcome variable was the proportion of patients with sepsis who were identified by EMS providers. ResultsApproximately 300 EMS providers were trained to use PRESS. A total of 498 patient encounters met criteria for study inclusion; 222 were excluded, primarily due to trauma. A total of 276 patient encounters were analyzed. Sepsis recognition by EMS providers increased from 12% pre-PRESS protocol to 59% post-PRESS protocol (p < 0.001). In a post-hoc analysis of the post-PRESS cohort, septic patients who were identified by EMS received antibiotics 24 min faster than septic patients who were not identified by EMS [28 min (IQR 18–48) vs 52 (IQR 27–98), respectively, p = 0.021]. ConclusionImplementation of an EMS sepsis screening and prehospital alert protocol was associated with an increase in sepsis recognition rates by EMS providers and a decrease in time to first antibiotic administration in the emergency department. Further studies are needed to evaluate the impact of this protocol in other populations.

Microgel-integrated, high-strength in-situ formed hydrogel enables timely emergency trauma treatment

High-strength hydrogels formed in situ through a convenient gel transition process are highly desirable for emergency treatment due to their ability to quickly respond to accidents. However, current in-situ formed hydrogels require a laborious precursor preparation process or lack sufficient mechanical strength. Herein, we reported a series of microgels that were capable of convenient in-situ transition to high-strength hydrogels from their easily portable form, thereby facilitating emergency treatment. Three kinds of microgels were derived from two types of hydrogen bonds (H-bonds; OH⋯OC, NH⋯OC) crosslinked preformed hydrogels, and all exhibited excellent stability when stored at room temperature. After mixing with water, all these microgels could undergo a quick hydration process and then transform into high-strength hydrogels in situ through H-bonds. Specifically, stronger H-bond crosslinked microgels could build hydrogels with higher mechanical strength, albeit at the cost of longer hydration and operation time. Nevertheless, the whole operation process could be finished within several minutes, and the resultant hydrogels could exhibit maximally megapascal-level compressive strength and tens of kilopascal storage modulus. In the comparison of emergency application performance with commercial chitosan hemostatic powder (CHP), we found that the microgels could stop accidental bleeding almost immediately, and the whole process from taking out the stored microgels to hemostasis could be completed within 15 s, which was superior to CHP. Overall, the results indicated that the in-situ formed microgel-based hydrogels with convenient gel-transition ability and high strength showed great potential in emergency treatments.