RESUMO
Adequate analgesia is one of the most important measures of emergency care in addition to treatment of vital function disorders and, if indicated, should be promptly undertaken; however, a large proportion of emergency patients receive no or only inadequate pain therapy. The numeric rating scale (NRS) is recommended for pain assessment but is not applicable to every group of patients; therefore, vital signs and body language should be included in the assessment. Pain therapy should reduce the NPRS to <5 points. Ketamine and fentanyl, which have an especially rapid onset of action, and also morphine are suitable for analgesia in spontaneously breathing patients. Basic prerequisites for safe and effective analgesia by healthcare professionals are the use of adequate monitoring, the provision of well-defined emergency equipment, and the mastery of emergency procedures. In a structured competence system, paramedics and nursing personnel can perform safe and effective analgesia.
Assuntos
Analgesia/métodos , Medicina de Emergência/métodos , Dor/tratamento farmacológico , Ferimentos e Lesões , Serviços Médicos de Emergência/métodos , Fentanila , Humanos , Ketamina , Manejo da Dor/métodos , Medição da DorRESUMO
We report the use of out-of-hospital extracorporeal life support (ECLS) in a 62-year-old patient with severe cardiogenic shock after cardiac arrest. The patient was successfully stabilized using the ECLS system in the pre-hospital setting. Hospital discharge with a good neurological outcome was possible after 23days.
Assuntos
Serviços Médicos de Emergência , Oxigenação por Membrana Extracorpórea , Parada Cardíaca Extra-Hospitalar/terapia , Choque Cardiogênico/terapia , Serviços Médicos de Emergência/métodos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Equipe de Assistência ao Paciente , Seleção de Pacientes , Medição de Risco , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. METHODS: This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. RESULTS: Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. CONCLUSION: Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..
Assuntos
Analgésicos Opioides/uso terapêutico , Medicina de Emergência , Medição da Dor , Analgesia , Alemanha , Humanos , Estudos Observacionais como Assunto , Manejo da DorAssuntos
Reanimação Cardiopulmonar/educação , Intubação Intratraqueal/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Current cardiopulmonary resuscitation (CPR) guidelines recommend airway management and ventilation whilst minimising interruptions to chest compressions. We have assessed i-gel™ use during CPR. METHODS: In an observational study of i-gel™ use during CPR we assessed the ease of i-gel™ insertion, adequacy of ventilation, the presence of a leak during ventilation, and whether ventilation was possible without interrupting chest compressions. RESULTS: We analysed i-gel™ insertion by paramedics (n=63) and emergency physicians (n=7) in 70 pre-hospital CPR attempts. There was a 90% first attempt insertion success rate, 7% on the second attempt, and 3% on the third attempt. Insertion was reported as easy in 80% (n=56), moderately difficult in 16% (n=11), and difficult in 4% (n=3). Providers reported no leak on ventilation in 80% (n=56), a moderate leak in 17% (n=12), and a major leak with no chest rise in 3% (n=2). There was a significant association between ease of insertion and the quality of the seal (r=0.99, p=0.02). The i-gel™ enabled continuous chest compressions without pauses for ventilation in 74% (n=52) of CPR attempts. There was no difference in the incidence of leaks on ventilation between patients having continuous chest compressions and patients who had pauses in chest compressions for ventilation (83% versus 72%, p=0.33, 95% CI [-0.1282, 0.4037]). Ventilation during CPR was adequate during 96% of all CPR attempts. CONCLUSIONS: The i-gel™ is an easy supraglottic airway device to insert and enables adequate ventilation during CPR.