RESUMO
BACKGROUND: The molecule CD14 acts as a receptor for the protein-bound endotoxin (lipopolysaccharide [LPS]) complex and mediates the cellular effects of LPS. The soluble formation, sCD14, is supposed to neutralize circulating LPS (i.e., LPS antagonist) or transfer LPS effects to endothelial cells (i.e., LPS agonist). OBJECTIVE: To elucidate the release of sCD14 per se in patients with major trauma in the early posttrauma period. Our a priori hypothesis was that sCD14 release depends on the plasma LPS concentration simultaneously measured. PATIENTS: In a prospective study, 65 patients with multiple injuries (Injury Severity Score, 9-75) were enrolled. The patients were rescued by the medical helicopter service and directly admitted to our clinics. The plasma concentrations of sCD14 (enzyme immunoassay) and LPS (chromogenic limulus amebocyte lysate test) were analyzed. The first blood sample was collected immediately at the accident site. The following samples were drawn at intervals from 2 hours to daily for 2 weeks. RESULTS: Sixty-one patients survived the observation time. Immediately after trauma, their mean sCD14 level was not different from that of healthy individuals. Two hours later, a pronounced increase of sCD14 was observed and sustained throughout the observation period. Even nonsurvivors showed an increased sCD14 release, but less pronounced. In all patients, plasma LPS levels were elevated during the first 12 hours. CONCLUSIONS: Major trauma caused an increased release of sCD14. This elevation, however, was not correlated to LPS levels or to the severity of trauma (estimated by trauma scores). We found no evidence that sCD14 levels are of prognostic value regarding survival. Furthermore, the release of sCD14 did not occur in an LPS-neutralizing manner, but rendered possible an LPS-independent mechanism.
Assuntos
Receptores de Lipopolissacarídeos/sangue , Lipopolissacarídeos/sangue , Ferimentos e Lesões/imunologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Solubilidade , Ferimentos e Lesões/sangueRESUMO
Chest trauma cases benefit to a great degree from adequate, timely initiated and consistent prehospital treatment. However, prehospital determination and evaluation of blunt chest trauma is associated with a high degree of uncertainty. The purpose of our study was to examine and determine, in a collective of 255 trauma patients, the value of additional prehospital pulse oximetric monitoring regarding the optimization of the emergency physician's diagnosis and treatment of blunt chest trauma. We conclude from our findings that, in addition to the physical examination, with the application of pulse oximetry the prehospital diagnosis of lung contusion as well as the early detection of tension pneumothorax are more accurate. Therefore, the combination of physical examination and pulse oximetric monitoring is a requirement for the optimization of prehospital diagnosis and therapy in blunt chest trauma.
Assuntos
Contusões/diagnóstico , Lesão Pulmonar , Monitorização Fisiológica , Oximetria , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Resgate Aéreo , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnósticoRESUMO
Coagulation disorders are of utmost importance in emergency surgery as well as for secondary organ failure of polytraumatized patients. In order to get hold of the early onset of these disorders, blood samples were harvested from 20 randomly selected patients (Injury Severity Score mean = 36.7 +/- 10.5) on the scene of emergency (mean = 18 [10-29] min after trauma) and at the time of hospital admission (mean = 78 [58-98] min after trauma). In addition to the activation of intravascular coagulation and the consumption of physiological inhibitors, high amounts (10- to 50-fold above normal) of degradation products (FgDP, FbDP, TDP, D-dimers) are present on the scene, already. The influence of hemodilution due to high-volume resuscitation is discussed.
Assuntos
Testes de Coagulação Sanguínea , Fibrinólise/fisiologia , Primeiros Socorros , Hemostasia/fisiologia , Traumatismo Múltiplo/sangue , Adolescente , Adulto , Aeronaves , Fatores de Coagulação Sanguínea/metabolismo , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Fibrinogênio/metabolismo , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Plasminogênio/metabolismo , Contagem de PlaquetasRESUMO
In a retrospective study conducted from 1.1. 1988-31.12.1991, we at our rescue helicopter station "Christoph 22" identified the special circumstances, which arise for the trauma anaesthesiologist during prehospital treatment of entrapped trauma patients. During the time frame of our study, we observed a continuous increase of patients suffering an entrapment trauma (from 8.3% to 15.9%). Motor vehicle accidents were the primary cause of entrapment (78.4%). Patients with an entrapment trauma in comparison to those without, to a much higher degree suffered more severe injuries (proportion of multi-system trauma: 49.4% versus 26%). Upon arrival of the trauma anaesthesiologist at the scene, the vital functions in the majority of the cases were already disturbed and unstable. The emergency medical measures required at the emergency scene therefore had to be timely and to the point and taken in close coordination with the technical rescue team. The proven procedures which we apply in such cases will be illustrated. Hospital of preference should, if possible, always be a trauma center.
Assuntos
Acidentes de Trânsito , Síndrome de Esmagamento/terapia , Primeiros Socorros , Ressuscitação , Adulto , Resgate Aéreo , Síndrome de Esmagamento/etiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/terapia , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Centros de TraumatologiaRESUMO
Every tenth person in Central Europe is a pollinosis patient. The time of ripening and release of pollen, as well as pollen flight, all depend on the weather. Because each year is different from every other, mean values from pollen calendars do not provide any practical help for allergy-sufferers. For this reason, in many European countries, measuring networks have been established during the last 10 years as a basis for forecasting the prevalence of airborne pollen for the following 2-3 days, in connection with the weather forecast. Cooperation and communication also exist on a European level, and a European Pollen Database had been established.
Assuntos
Pólen , Rinite Alérgica Sazonal/etiologia , Bases de Dados Factuais , Monitoramento Ambiental , Europa (Continente) , Alemanha , HumanosRESUMO
The basics of the acute management of severe diving accidents are outlined by means of 25 patients (20 patients presented with decompression sickness, 5 suffered from a barotrauma of the lungs with consecutive air embolism) treated at our facilities. Contrary to widespread notion, disturbed vital functions have to be treated by intensive care measures, prior to the definite recompression therapy. These are: (1) Treatment of generalized or localized tissue hypoxia secondary to bubble-generation; (2) puncture of a (valvular-) pneumothorax after a pulmonary barotrauma; (3) haemodynamic stabilization when cardiac or spinal shock is present; (4) improvement of the rheological situation. When vital functions are unstable or endangered, these patients must not be transported in a monoplace chamber. This type of chamber does not leave any access to the patient in case of a deteriorating status. Since the severe diving accident mostly turns out to be a problem of intensive care medicine in close combination with the recompression therapy, the continuous integration of the recompression protocol with a comprehensive intensive care therapy is considered crucial.
Assuntos
Cuidados Críticos/métodos , Doença da Descompressão/terapia , Mergulho/efeitos adversos , Adulto , Barotrauma/terapia , Terapia Combinada , Embolia Aérea/terapia , Feminino , Seguimentos , Hemodiluição/métodos , Humanos , Oxigenoterapia Hiperbárica , Masculino , Oxigenoterapia , Embolia Pulmonar/terapiaRESUMO
Information about the use of data processing systems in prehospital emergency medicine were collected, using a questionnaire sent to all German rescue helicopter bases. Twenty-seven of the 42 German rescue helicopter bases returned the questionnaire. At present, only 15 of them take advantage of electronic data processing. All of them enter their data manually by keyboard, automatic data transfer by means of a bar code reader is available at one base only. The stored data are used for statistical analysis (n = 15), quality assessment (n = 10), administration (n = 10), research (n = 9) and education (n = 7). Based on the data of this survey, one fifth of those who replied use their computer only for administrative purposes, the other also manage patient and mission data with their computer systems. Today, documentation of a rescue mission consists of patient data, vital data, mission data and information about the procedures carried out. The use of a computer system, however, requires more time and work than a handwritten record, when most of the data have to be entered manually using a keyboard. Future developments may include automated data transfer and digitization of handwritten documents to decrease the workload of the staff. For the automation of data transfer, configuration and synchronisation a standardized interface in all medical devices is required. There is a clear need for the use of data processing systems in emergency medicine.
Assuntos
Processamento Eletrônico de Dados , Serviços Médicos de Emergência , Aeronaves , Eficiência , Alemanha , Inquéritos e QuestionáriosRESUMO
Pulse oximetric monitoring in air rescue service (rescue helicopter) is primarily influenced by motion artifacts (especially those of a passive nature), by low perfusion and by the problem of probe dislocation. In a prospective study involving 162 unselected emergency patients treated by the medical team of the emergency helicopter service "Christoph 22" (Ulm), we studied the possibility of reducing these adverse factors by applying available state-of-the-art technology, such as ECG-synchronization and adhesive probes. By applying the thus modified methods of monitoring, the interference factor was reduced to S = 0.056, that is only 5.6% of measurement time was adversely effected. The increase in measurement stability resulted from the reduction in number of described artifacts (motion artifacts and low perfusion), as well as from the reduction in duration of interfered measurement time. ECG-synchronization very effectively influenced the passive motion artifacts. Their frequency was reduced by the factor 8.2, respectively 42. An effective reduction in number of probe dislocations can be achieved by applying adhesive probes. The high costs of such probes presently limits their application. Radiation can be eliminated by redesigning the probe. ECG-synchronization of pulse oximetric signal has proved to be a method to reduce the artifacts frequently experienced in air rescue and has considerably contributed to the increase of emergency patient safety.
Assuntos
Aeronaves , Serviços Médicos de Emergência , Monitorização Fisiológica/métodos , Oximetria/instrumentação , Transporte de Pacientes , Artefatos , Eletrocardiografia , Humanos , Oximetria/normas , Estudos ProspectivosRESUMO
The introduction of pulse oximetric monitoring in prehospital emergency medicine considerably contributed to emergency patients' safety, stability and protection. As inherent in any method of measurement, certain factors can interfere with it and limit its practical application. The emergency helicopter service at Ulm, in a prospective study involving 400 patients, systematically collected data on these limiting factors and evaluated them. The index "S" was established to quantify the time lost due to malfunctioning. Within the study group, the index average was S = 0.269, that is 26.9% of measurement time was subject to interference. The major cause was motion artifacts (68%) sensor probe dislocation (15%), low perfusion (14%) and radiation (3%). Regarding the volume of time lost due to specific interfering factors, motion artifacts (61.8%) and low perfusion (25.5%) were dominant, followed by sensor probe dislocation (10.3%) and radiation (2.4%). Interference therefore, both in time and frequency was primarily due to motion artifacts and low perfusion. The conclusions from this study led to the evaluation of two methods by which the interfering factors could be reduced: 1. ECG-synchronisation of the pulse oximetric signal; 2. The use of adhesive sensors.--The degree of increase in pulse oximetric measurement stability achieved by these two methods will be investigated in part 2 of this study.
Assuntos
Aeronaves , Monitorização Fisiológica/instrumentação , Traumatismo Múltiplo/fisiopatologia , Oximetria/instrumentação , Transporte de Pacientes , Artefatos , Eletrodos , Humanos , Troca Gasosa Pulmonar/fisiologia , Valores de Referência , Choque/fisiopatologia , Traumatismos Torácicos/fisiopatologiaRESUMO
Trauma patients are at great risk of accidental hypothermia (body temperature [BT] < 36 degrees C). Hypothermia influences the functioning of all organ systems and can lead to pathological changes, which in turn additionally complicate the trauma. Furthermore, hypothermia can, e.g., by influencing blood coagulation (reduction of thrombocyte aggregation, increased fibrinolysis) have a markedly unfavourable impact upon the in-hospital surgical treatment of the trauma patient. In a prospective study involving 302 trauma patients treated during primary helicopter rescue missions over a 1-year period, we studied the following factors: (1) incidence and degree of severity of hypothermia; (2) seasonal influence; (3) possibility of individual risk groups within the study group; (4) changes in BT during the prehospital treatment phase; and (5) their consequences for emergency treatment. METHOD. BT was taken upon commencement of emergency treatment and upon release of the patient to the receiving hospital. To avoid possible damage to the patient's tympanic membrane by the thermometer probe, we excluded all patients under 16 years of age and those with an indication of an ear or temporal-bone injury. In all cases standardized patient positioning was applied. The statistical evaluation was performed utilizing descriptive presentations and the Mann-Whitney U test and chi-square test. RESULTS. During study period, a total of 302 trauma patients were treated. On 228 of these, prehospital temperature monitoring was performed (151 males and 77 females, average age 41.8 years). Because of the established criteria for exceptions and equipment malfunction, no monitoring was performed on 74 patients. Traffic accidents (69%) were the major cause of injury (Table 2), predominantly the group with NACA III (32%), followed by NACA IV (22%) and NACA V (18%) (Table 3); 27% had multi-system trauma. BT monitoring disclosed that 49.6% or almost every second trauma patient, had hypothermia. The proportion of hypothermia II degrees (BT 34 degrees-30 degrees C) versus hypothermia III degrees (BT < 30 degrees C) was 6.6% to 0.5%. Our statistical evaluation did not disclose any significant connection between season of the year and frequency of accidental hypothermia. Special risk factors in regard to frequency and degree of severity turned out to be "entrapment" (98.1% of patients with an entrapment trauma [ET] versus 34.5% without such; P < 0.001) and age (56.8% of patients > 65 years of age without ET and 100% with ET; P < 0.001) (Figs. 2, 3). No significant changes in BT were noted during the prehospital treatment phase. Clinical symptoms pointing to hypothermia or other indicators, i.e., shivering, were only noted in 4.4% of the cases where the patients BT was below normal. CONCLUSION. Based upon our findings, accidental hypothermia poses a relevant problem in the prehospital treatment of trauma patients. It is not limited to a special season of the year. The variability or total absence of definite diagnostic symptoms underlines the necessity for prehospital BT monitoring, whereby tympanic-membrane thermometry has proven to be a worthwhile method.
Assuntos
Serviços Médicos de Emergência , Hipotermia/etiologia , Ferimentos e Lesões/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipotermia/epidemiologia , Hipotermia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estações do AnoRESUMO
Hyperbaric Oxygen (HBO) therapy is a kind of medical treatment in which a patient breathes 100% of oxygen inside a pressure chamber while the pressure of the chamber is increased to a point higher than sea level pressure. It is strongly based on clearly defined physical laws and physiological regularities. For the clinical use of HBO therapy, according to international recommendations, there are several commonly accepted indications in which HBO either is the only causative life-saving kind of treatment, or is an essential and oftenly decisive component of a comprehensive interdisciplinary intensive care therapy. Among potential adverse effects, barotrauma of the lungs and especially oxygen toxicity to the central nervous system have to be mentioned. Clinical use of HBO therefore requires special knowledge of its effects, risks, and adverse effects, a clear and distinct indication, and the ability and skills to keep complications under control by means of intensive care or emergency medical measures. The clinical use of hyperbaric oxygen with its interdisciplinary-like character of emergency medicine or intensive care therapy therefore should be an additional, most interesting field of activity for the anaesthesiologist.
Assuntos
Anestesiologia , Oxigenoterapia Hiperbárica , Animais , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigenoterapia Hiperbárica/instrumentação , Oxigenoterapia Hiperbárica/métodosRESUMO
Severely injured patients, in particular, benefit from initiation of endotracheal intubation and controlled ventilation before hospital admission. The most frequent and most serious mishap of this emergency procedure is inadvertent esophageal tube placement. A reliable and simple determination of proper tube placement involves capnometry, the measurement of carbon dioxide concentration during the respiratory cycle. The purpose of this study was to evaluate the dependability of semi-quantitative capnometry in verifying proper tube placement in the prehospital treatment of trauma patients. First, we determined and tested the suitability of the equipment used in this study (STAT CAP) in 40 patients under controlled hospital conditions; subsequently, we tested it under prehospital conditions on 40 trauma patients. Within the two study groups, the STAT CAP proved to be of high sensitivity (1.0) and specificity (1.0) in identifying tracheal tube position immediately after intubation manoeuvre, even in patients with a shock index > 1 (n = 14) and patients with cardiac arrest (n = 3). In cases of tracheal tube position, a CO2 signal was noted after two ventilations, on average, in both study groups. The average initial CO2 value recorded amongst the hospital study group was 30-50 mmHg, against 20-30 mmHg in the prehospital trauma group. The traditional signs used to verify endotracheal tube placement (direct visualization of the vocal cords and auscultation of breath sounds upon the chest) failed in three cases amongst the prehospital trauma group; in all of these cases the STAT CAP detected the (tracheal) tube placement correctly. We conclude that the STAT CAP reliably detects tracheal placement of endotracheal tube in non-arrested patients. In the arrested patient, interpretation of CO2 nonappearance requires caution. In addition to the traditional clinical signs, semi-quantitative capnometry is a meaningful supplement to verify tracheal tube placement in the prehospital management of trauma patients.
Assuntos
Testes Respiratórios/instrumentação , Dióxido de Carbono/análise , Emergências , Intubação Intratraqueal/instrumentação , Monitorização Fisiológica/instrumentação , Traumatismo Múltiplo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Primeiros Socorros/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Oxigenoterapia/instrumentação , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To study outcome from severe head injury (SHI: GCS < or = 8) and to investigate impact of prehospital factors and clinical intensive care parameters on outcome. To compare with former study results (1980-88) of our clinical setting. METHODS: Retrospectively, the history of 228 patients with SHI treated between 1988 and 1995 was looked into. The outcome was measured with the Glasgow Outcome Scale (GOS) post intensive care (median 9, min-max 2-77 days) and 6 months after trauma by a questionnaire. The GOS was related to age, Glasgow Coma Scale (GCS on the scene), prehospital hypotension and hypoxia (HH), intracranial pressure (ICP), cerebral perfusion pressure (CPP), intensive therapy including Tromethamine and/or Thiopentone. The rate of infections was determined. RESULTS: Increasing age influences outcome negatively. Prehospital GCS and HH were significantly correlated with outcome. GOS of 30 patients with HH: GOS 1: 53%, GOS 2 + 3: 27%, GOS 4 + 5: 20%. GOS of 40 patients without HH: GOS 1: 25%, GOS 2 + 3: 10%, GOS 4 + 5: 65%. During intensive care the level of CPP (not ICP) as well as tromethamine and/or thiopentone treatment for control of elevated ICP were significantly correlated with outcome. Mortality rate in 32 patients with CPP < 50 mmHq was 69%, in 29 patients with CPP > 50 mmHg only 20%. Patients treated additionally with Tromethamine and Thiopentone because of uncontrollable intracranial hypertension showed a significantly worse outcome: GOS 1: 66%, GOS 2 + 3: 6%, GOS 4 + 5: 28%, compared to those who needed neither Tromethamine nor Thiopentone: GOS 1: 27%, GOS 2 + 3: 18%, GOS 4 + 5: 55%. Thiopentone treatment was not associated with an increased rate of pulmonary and other infections. In comparison to our former outcome study, covering the years 1980-88, we have not seen any improvements in outcome, despite modifications in intensive care protocols. CONCLUSIONS: Prehospital hypotension and hypoxia have a significant negative impact on outcome by causing secondary brain damage. Despite various modifications in intensive care therapy an unchanged portion of secondary brain damage will not prove treatable. Therefore, prevention or early aggressive treatment of hypotension and hypoxia is the most promising way of improving outcome after severe head injury at the moment.
Assuntos
Lesões Encefálicas/terapia , Crânio/lesões , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Moduladores GABAérgicos/uso terapêutico , Escala de Coma de Glasgow , Humanos , Lactente , Hipertensão Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tiopental/uso terapêutico , Resultado do Tratamento , Trometamina/uso terapêuticoRESUMO
Between 50 to 60% of all polytraumatized patients have a thoracic injury with a mortality of 30 to 60%. The first diagnostic steps involving symptoms such as in- or expiratory pain, emphysema of the skin, flail chest or sipping noise lead via clinical examination to first and often definitive therapeutic procedures, i.e. intubation, artificial respiration and insertion of chest tube. X-ray of the chest, computed tomography as well as ultrasonic screening and monitoring of arterial blood gases are important in in-door technical diagnosis. The decision for emergency room thoracotomy or a regular or delayed operation has to be made at times. Complications (20%) to consider are pneumo- and haematothorax, pleural rind, pneumonia, broncho-pleural fistula and most of all pleural empyema.
Assuntos
Lesão Pulmonar , Traumatismo Múltiplo/cirurgia , Seguimentos , Hemotórax/mortalidade , Hemotórax/cirurgia , Humanos , Pulmão/cirurgia , Traumatismo Múltiplo/mortalidade , Pneumotórax/mortalidade , Pneumotórax/cirurgia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Taxa de SobrevidaRESUMO
Coagulation changes due to polytrauma are considered to be an important determinant for the outcome. In this context, physiological inhibitors of activated coagulation are highlighted with special reference to antithrombin-III (AT-III). Blood samples of 20 randomly selected adults with polytrauma (Injury Severity Score mean = 36.7 +/- 8.6) were investigated. To investigate the very early onset of coagulation changes, samples were taken as early as possible at the site of emergency (mean = 18.3 +/- 5.5 min. after trauma) as well as at hospital admission (mean = 78.0 +/- 10.4 min.). By means of a specially designed "mini-lab", basic processing of the samples harvested (centrifugation, pipetting, freezing) was done on the spot to obtain haemostaseological results that agree as closely as possible with the subsequent analyses. Due to the activation of intravascular coagulation as well as the consumption of physiological inhibitors, comprehensive coagulation disturbances become obvious at the time of hospital admission. These are intensified by haemodilution as a consequence of high-dose fluid replacement. However, significantly elevated levels of specific coagulation reaction products (thrombin-antithrombin-III-complex) give evidence of the consumption of inhibitory potential exceeding haemodilution.
Assuntos
Antitrombina III/fisiologia , Coagulação Sanguínea/fisiologia , Glicoproteínas/fisiologia , Traumatismo Múltiplo/fisiopatologia , Proteína C/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína SRESUMO
The technical equipment necessary for modern anaesthesia and intensive care medicine needs special and organized outfit control of the apparatus used and of their operation and proper function. Setting up of a centre for maintenance work on anaesthetic equipment is a possibility. Studies have shown that the necessary technical and hygienic maintenance work may be subdivided into 12 working phases each need special working sites and technical equipment corresonding to the requirements. The above systematic study is recommended to decrease risks assoicated which technique and hygiene.
Assuntos
Anestesiologia/instrumentação , Unidades de Terapia Intensiva , Serviço Hospitalar de Engenharia e Manutenção , Desinfecção , Equipamentos e Provisões Hospitalares , Serviços Hospitalares Compartilhados , Unidades HospitalaresRESUMO
The early diagnosis and adequate treatment of respiratory complications in trauma cases has a decisive influence upon the patients' posttraumatic development. Pulse oximetry enables us to evaluate and monitor the prehospital respiratory situation objectively for the first time. Within a prospective study conducted from October 1988 to October 1989 in 336 unselected, primarily traumatized, emergency patients rescued by our "SAR Ulm 75" helicopter team, to determine the possibilities and limitations of this method, we maintained continuous pulse oximetric monitoring in all cases. The practical applicability and functional stability of the pulse oximeters used were adequate. On-the-spot intubation was necessary in 45% of the patients (or they were intubated prior to our taking over). Oxygen inhalation by nasal cannula was needed in 55%. While not being decisive for immediate intubation, monitoring with a pulse oximeter does play an essential role in controlling respiratory therapy. In 32% of our cases, pulse oximetric monitoring permitted early adjustment of the respiratory therapy to meet the patients requirements. This method is of special value in disclosing life-threatening respiratory complications (9.3%) i.e., valve pneumothorax. Within a group with a high percentage of multiple traumas (27%) and thorax traumas (39%), this was of enormous assistance in the differential diagnosis. Level and rate of increase of oxygen saturation can be an indication of the severity of a thorax trauma. The limitations of pulse oximetric monitoring, especially those resulting from low peripheral perfusion in trauma cases (7 patients), are fairly rare.
Assuntos
Monitorização Fisiológica , Oximetria , Transtornos Respiratórios/etiologia , Ferimentos e Lesões/complicações , Adulto , Pré-Escolar , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Estudos Prospectivos , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/terapia , Terapia Respiratória , Traumatismos Torácicos/complicaçõesRESUMO
UNLABELLED: In prehospital emergency treatment, the timely establishment of a secure vascular access, especially in infants and small children, can be difficult or even impossible. An alternative to the puncture of peripheral or central veins is intraosseous (IO) puncture However, experience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present. After intensive theoretical and practical training of our trauma anaesthesiologists, IO puncture was introduced in our rescue helicopter program "Christoph 22" as an alternative to peripheral or central venous puncture in the prehospital treatment of patients up to 6 years of age. IO puncture is indicated after a maximum of three failed peripheral venous puncture attempts. The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture algorithm in order to subject them to critical review and evaluation. MATERIALS AND METHODS: A restrospective study by the rescue helicopter service "Christoph 22" was carried out for the period 1 June 1993-31 August 1995. RESULTS: In a total of 1,455 primary rescue missions flown, the proportion of patients < and = 6 years of age, was 6.2% (n = 90). Ten patients in this partial collective (11.1%) were subjected to IO puncture (Fig. 3). In all of these cases (10/10), the first IO puncture attempt was successful. A standardized puncture technique was performed using the proximal tibia. The time required to successful placement of the IO infusion line was < and = 60 s in all cases. Complications, especially incorrect needle position, did not occur during the study period. Materials infused by IO infusion before hospitalisation included crystalloids (Lactated Ringer's, Päd OP) as well as colloids (hydroxyethylstarch, human albumin), adrenaline, atropine, ketamine, thiopentone, diazepam, fentanyl, succinylcholine, and vecuronium (Table 3). Prehospital induction of general anaesthesia using the IO infusion line was required by 2/10 children; dosage and onset of administered drugs was described by the trauma anaesthesiologists as being similar to that using an i.v. infusion line. Seven of the patients had been treated prior to the arrival of the rescue helicopter team by other emergency medical personnel; in all of these cases multiple peripheral and in 3 additional central venous puncture attempts had failed (duration of attempts: 10-50 min). Upon arrival of the rescue helicopter, 5 of these patients had been pulseless and non-breathing (Table 2). CONCLUSION: The IO infusion technique has proven to be a simple, fast, and safe alternative method of emergent access to the vascular system.