RSS 1.0Emergency Department (ED)
Recent Submissions
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Airway management in patients with suspected or confirmed cervical spine injury. AnaesthesiaProviding an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance.
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The offload study: A prospective observational study of the time to offload a patient from an ambulance or helicopter into an emergency department or percutaneous coronary intervention centreProviding an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance.
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Leadership training in emergency medicine: A national surveyEmergency medicine (EM) is a uniquely stressful environment in which leadership training could improve individual and team performance, patient outcomes, well-being, and EM career intentions. The primary aim was to evaluate EM-specific leadership training (EMLeaders) compared to no leadership training. A secondary comparison was with other forms of leadership training.
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Prehospital critical care beyond advanced life support for out-of-hospital cardiac arrest: A systematic review.To assess the clinical outcomes of patients with out-of-hospital cardiac arrest attended by prehospital critical care teams compared to non-critical care teams.
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Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital CareRoad traffic injury is the leading cause of death among young people globally, with motor vehicle collisions often resulting in severe injuries and entrapment. Traditional extrication techniques focus on limiting movement to prevent spinal cord injuries, but recent findings from the EXIT project challenge this approach. This paper presents updated recommendations from the Faculty of Pre-Hospital Care (FPHC) that reflect the latest evidence on extrication practices.
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Student advanced trauma management and skills (SATMAS): a validation study.Despite trauma accounting 9% of global mortality, it has been demonstrated that undergraduate trauma teaching is inadequate nationally and worldwide. With COVID-19 exacerbating this situation, a scalable, accessible, and cost-effective undergraduate trauma teaching is required.
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Journal update monthly top fiveNo Abstract
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Sedation and Field Amputation. In: Lax, PWhen a patient is physically trapped by a limb with imminent threat to life from cardiac arrest due to hypovolaemia, or a scene emergency such as fire or flooding, and there is no other method of rapid extrication then life-saving limb amputation may be necessary. Advanced prehospital practitioners should have the equipment, training and organisational governance to be able to undertake these rare time-critical procedures in the field. Whilst the actual surgical procedure of a guillotine amputation is very simple, the decision-making to undertake the procedure is more stressful and a successful outcome requires adequate preparation and briefing of the team. This chapter covers the key indications and considerations for field amputation including helpful advice to support the decision, as well as considerations before starting the procedure, after the patient has been extricated and after handover at hospital. This chapter describes the use of procedural sedation for amputation as well as other painful procedures which may be undertaken in the prehospital environment. Practitioners should have a comprehensive understanding of the pharmacology, dosing and potential side effects of the sedative drugs available in their formulary, as well as having experience and training to optimally provide sedation in the field.
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Shock in Trauma.No Abstract
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Summarising in medical emergencies: The role of the discourse marker soThis article is concerned with the in situ negotiation of epistemic authority through the mobilisation of summaries in the context of medical emergencies. It focuses on the use of the discourse marker so in prefacing summaries as a strategy for claiming epistemic primacy, with particular attention being paid to so's multimodal accomplishment. Taking an interactional sociolinguistic approach, we bring together simulated and real-life trauma emergencies and zoom in on the role of the institutionally defined team leader.
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Resuscitation with pre-hospital blood products in adults with trauma-related haemorrhagic shock: the RePHILL RCTBackground: The treatment of traumatic haemorrhagic shock has been transformed through better haemorrhage control, use of tranexamic acid and use of blood products. The improved survival seen from these strategies has stimulated an interest in pre-hospital transfusion. Objectives: To determine if the clinical effectiveness of resuscitation with red blood cells and lyophilised plasma was superior to 0.9% saline for improving tissue perfusion and reducing mortality in adults with haemorrhagic shock following major trauma. Design: A multi-centre, allocation concealed, open-label, parallel group, randomised controlled trial (with internal pilot). Setting: The trial was conducted in four civilian pre-hospital critical care services who operated within the National Health Service (NHS) England Major Trauma Networks. Participants: Adults (aged ≥16 years) who had sustained traumatic injuries, were attended by a pre-hospital emergency medical team and were hypotensive (systolic blood pressure <90 mmHg or absence of radial pulse) as a consequence of traumatic haemorrhage were eligible for inclusion. The exclusion criteria were known or apparently <16 years, blood administered on scene prior to arrival of the RePHILL team, traumatic cardiac arrest where (1) the arrest occurred prior to arrival of the team and/or (2) the primary cause is not hypovolaemia, refusal of blood product administration, known Jehovah’s Witness, pregnancy, isolated head injury without evidence of external haemorrhage, prisoners in the custody of HM Prison and Probation Service. Interventions: Participants were randomised to receive up to either two units each of red blood cells and lyophilised plasma or up to 1 L 0.9% saline. Treatment was administered through the intravenous or intraosseous route. Main outcome measures: The primary outcome was a composite of episode mortality and/or impaired lactate clearance. The secondary outcomes included the individual components of the primary outcome. Results: From 6 December 2016 to 2 January 2021, pre-hospital medical teams randomised 432 participants to red blood cell/lyophilised plasma (n = 209) or 0.9% saline (n = 223) out of a target sample size of 490. Most participants were white (62%), males (82%), median age 38 (interquartile range 26 to 58), involved in a road traffic collision (62%) with severe injuries (median injury severity score 36, interquartile range 25 to 50). Prior to randomisation participants had received on average 430 ml crystalloid fluids and tranexamic acid (90%). The primary outcome occurred in 128/199 (64.3%) of participants randomised to red blood cell/lyophilised plasma and 136/210 (64.8%) randomised to 0.9% saline [adjusted risk difference –0.025% (95% confidence interval –9.0% to 9.0%), p = 0.996]. The event rates for the individual components of the primary outcome, episode mortality and lactate clearance were not statistically different between groups [adjusted average differences −3% (−12% to 7%); p = 0.57 and −5% (−14% to 5%), p = 0.33, respectively]. Limitations: Recruitment stopped prematurely due to disruption caused by the COVID-19 pandemic. Future work: Identify the characteristics of patients who may benefit from pre-hospital blood products and whether alternative transfusion regimens are superior to standard care. Conclusions: The trial did not demonstrate that pre-hospital red blood cell/lyophilised plasma resuscitation was superior to 0.9% saline for trauma-related haemorrhagic shock.
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Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial.To determine the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) when used in the emergency department along with standard care vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage.
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Nonfreezing Cold Injuries Among Long-Distance Polar RowersNonfreezing cold injury (NFCI) is a peripheral cold injury that occurs when the extremities are exposed to cold temperatures, at or near the freezing point, for sustained periods of time (48-96 h at temperatures of usually around 0 to 6°C with associated wind chill). Although NFCI often goes unreported and may be underdiagnosed, it is a cause of significant morbidity in those working in cold conditions, particularly those in the military. Thus, further research into the prevention, recognition, and treatment of NFCI is warranted.
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The cerebral venous system and hypoxia.Most hypobaric hypoxia studies have focused on oxygen delivery and therefore cerebral blood inflow. Few have studied venous outflow. However, the volume of blood entering and leaving the skull (∼700 ml/min) is considerably greater than cerebrospinal fluid production (0.35 ml/min) or edema formation rates and slight imbalances of in- and outflow have considerable effects on intracranial pressure. This dynamic phenomenon is not necessarily appreciated in the currently taught static "Monro-Kellie" doctrine, which forms the basis of the "Tight-Fit" hypothesis thought to underlie high altitude headache, acute mountain sickness, and high altitude cerebral edema. Investigating both sides of the cerebral circulation was an integral part of the 2007 Xtreme Everest Expedition. The results of the relevant studies performed as part of and subsequent to this expedition are reviewed here. The evidence from recent studies suggests a relative venous outflow insufficiency is an early step in the pathogenesis of high altitude headache. Translation of knowledge gained from high altitude studies is important. Many patients in a critical care environment develop hypoxemia akin to that of high altitude exposure. An inability to drain the hypoxemic induced increase in cerebral blood flow could be an underappreciated regulatory mechanism of intracranial pressure