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1.
Rev Med Suisse ; 15(667): 1866-1869, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617974

RESUMO

Crystalloid-type solutions are currently recommended for volume resuscitation. Although historically considered as «â€…physiological saline ¼, NaCl 0.9 % has a high concentration of sodium and chloride that can lead to metabolic acidosis and impaired renal function when large volumes are used. Recent evidence confirms that use of low-chloride crystalloids (so-called balanced solutions) could reduce the occurrence of renal failure and should be preferred during high volume resuscitation.


Assuntos
Cuidados Críticos/métodos , Hidratação , Ressuscitação , Humanos , Insuficiência Renal/prevenção & controle , Solução Salina
2.
Am Surg ; 85(8): 861-864, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560304

RESUMO

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group (P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent (P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively (P = 0.73). Blood product utilization was significantly lower in the TEG group (P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.


Assuntos
Anticoagulantes/administração & dosagem , Lesões Encefálicas Traumáticas/sangue , Hemorragias Intracranianas/sangue , Ressuscitação/métodos , Tromboelastografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Acta Chir Orthop Traumatol Cech ; 86(3): 223-227, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31333189

RESUMO

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.


Assuntos
Aorta/cirurgia , Oclusão com Balão , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Acidentes de Trânsito , Humanos , Traumatismo Múltiplo/etiologia , Traumatismo Múltiplo/terapia
4.
Emerg Med Clin North Am ; 37(3): 395-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262411

RESUMO

Patients in shock present frequently to the emergency department. The emergency physician must be skilled in the resuscitation of both differentiated and undifferentiated shock. Early, aggressive resuscitation of patients in shock is essential, using macrocirculatory, microcirculatory, and clinical end points to guide interventions. Therapy should focus on the restoration of oxygen delivery to match tissue demand. This article reviews the evidence supporting common end points of resuscitation for common etiologies of shock and limitations to their use.


Assuntos
Ressuscitação , Choque/terapia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/prevenção & controle , Pressão Arterial/fisiologia , Biomarcadores , Circulação Sanguínea/fisiologia , Dióxido de Carbono/sangue , Débito Cardíaco/fisiologia , Medicina de Emergência , Homeostase/fisiologia , Humanos , Hipotensão/prevenção & controle , Ácido Láctico/sangue , Oxigênio/sangue , Sepse/fisiopatologia , Choque/sangue , Urina
5.
Emerg Med Clin North Am ; 37(3): 409-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262412

RESUMO

Resuscitative ultrasound describes point-of-care applications that provide diagnostic information, physiologic monitoring, and procedural guidance in critically ill patients. This article reviews the evaluation of ventricular function, identification of pericardial effusion and tamponade, evaluation of preload and fluid responsiveness, and hemodynamic monitoring, as some of the main applications where this modality can help emergency physicians during resuscitation of critically ill patients.


Assuntos
Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ressuscitação , Velocidade do Fluxo Sanguíneo , Tamponamento Cardíaco/diagnóstico por imagem , Estado Terminal , Medicina de Emergência , Serviço Hospitalar de Emergência , Hemodinâmica , Humanos , Monitorização Fisiológica , Derrame Pericárdico/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler , Veia Cava Inferior/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
6.
Emerg Med Clin North Am ; 37(3): 569-581, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262422

RESUMO

The emergency department resuscitation of the critically ill geriatric patient is challenging and can be fraught with peril. The anatomic and physiologic changes that occur with aging can significantly influence the recognition of critical illness and the logistics of resuscitation itself. This article discusses the relevant physiologic changes with aging, the effect of these changes on clinical manifestations of critical illness in older adults, and the core principles of resuscitation in this population, with specific attention to sepsis and trauma care. In addition, end-of-life care is also discussed.


Assuntos
Estado Terminal/terapia , Serviço Hospitalar de Emergência , Ressuscitação , Idoso , Fenômenos Fisiológicos Cardiovasculares , Disfunção Cognitiva/complicações , Medicina de Emergência , Fragilidade/complicações , Avaliação Geriátrica , Taxa de Filtração Glomerular , Humanos , Hipnóticos e Sedativos/uso terapêutico , Imunossenescência , Limitação da Mobilidade , Manejo da Dor , Farmacocinética , Exame Físico , Fenômenos Fisiológicos Respiratórios , Sepse/diagnóstico , Sepse/terapia , Assistência Terminal , Equilíbrio Hidroeletrolítico , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
7.
Am Surg ; 85(6): 654-662, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267908

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an innovative method by which noncompressible bleeding in the torso can be mitigated until definitive treatment can be obtained. To perform a systematic review of the literature on the use of the REBOA in trauma patients. An English and Spanish literature search was performed using MEDLINE, PubMed, and Scopus, from 1948 to 2018. Keywords used were aortic balloon occlusion, resuscitative endovascular balloon, REBOA, hemorrhage, and resuscitative endovascular balloon occlusion of the aorta. The eligilibility criteria included only original and human subject articles. Nontrauma patients, nonbleeding pathology, letters, single case reports, reviews, and pediatric patients were excluded. Two hundred forty-six articles were identified, of which 17 articles were included in this review. The total number of patients was 1340; 69 per cent were men and 31 per cent women. In 465 patients, the aortic zone location was described: 83 per cent the balloon was placed in aortic zone I and 16 per cent in zone III. Systolic blood pressure increased at an average of 52 mmHg before and after aortic occlusion. Although 32 patients (2.4%) presented clinical complications derived from the procedure, no mortality was reported. The trauma-related mortality rate was 58 per cent (776/1340). REBOA is a useful resource for the management of noncompressive torso hemorrhage with promising results in systolic blood pressure and morbidity. Indications for its use include injuries in zones 1 and 3, whereas it is not clear for zone 2 injuries. Additional studies are needed to define the benefits of this procedure.


Assuntos
Ruptura Aórtica/terapia , Oclusão com Balão/métodos , Ressuscitação/métodos , Lesões do Sistema Vascular/terapia , Ferimentos e Lesões/terapia , Aorta Torácica/lesões , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Ressuscitação/mortalidade , Medição de Risco , Taxa de Sobrevida , Ferimentos e Lesões/diagnóstico
9.
11.
J Nurs Adm ; 49(7-8): 372-376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335519

RESUMO

Creating nurse-driven protocols empower nurses to practice at the top of their scope and provide early interventions. This article describes the development and implementation of an evidence-based, nurse-driven resuscitation protocol for cardiac surgical patients who suffer cardiac arrest using a theoretical framework and leadership-driven process. Readers will gain knowledge of the collaborative process required to develop and implement a complex practice change. Process measures, outcomes, and lessons learned are presented.


Assuntos
Enfermagem Baseada em Evidências , Implementação de Plano de Saúde/organização & administração , Enfermeiras Administradoras , Ressuscitação/métodos , Parada Cardíaca , Humanos , Unidades de Terapia Intensiva , Melhoria de Qualidade , Ressuscitação/estatística & dados numéricos , Sobrevida
13.
Anaesthesia ; 74(10): 1290-1297, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350856

RESUMO

There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/educação , Segurança do Paciente , Pediatria/educação , Adulto , África Central , África Oriental , Criança , Competência Clínica , Comunicação , Avaliação Educacional , Docentes , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Pessoa de Meia-Idade , Ressuscitação , Ensino , Adulto Jovem
14.
Stud Health Technol Inform ; 262: 67-70, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349267

RESUMO

Emergencies involving children are rare events. Due to the associated lack of routine and special features in pediatric resuscitation, it is prone to errors and the results are unsatisfactory. One way of tackling this problem is to use assistance services. However, due to the process, these services cannot be easily integrated. One possibility is the use of Head Mounted Displays. These are often controlled via voice commands. With medical terms, the voice control implemented as standard can quickly become unusable. A wearable app was therefore developed for this paper and evaluated according to ISO/IEC 30122-2:2017 to determine the extent to which the voice control of a state-of-the-art smartglass works in quiet and noisy conditions for use during a resuscitation. Since the commands were well understood and the app could be reliably controlled, the use of voice control in an assistance service is conceivable.


Assuntos
Ressuscitação , Percepção da Fala , Dispositivos Eletrônicos Vestíveis , Criança , Emergências , Humanos , Ruído , Fala
15.
J Spec Oper Med ; 19(2): 134-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201769

RESUMO

This case report describes the technical aspects in first use of a novel field improvised autologous transfusion (FIAT) system. It highlights a potential solution for specific trauma patients during advanced resuscitative care (ARC) and prolonged field care (PFC) scenarios where other blood products are not available.


Assuntos
Transfusão de Sangue Autóloga/métodos , Medicina Militar , Ressuscitação , Lesões Relacionadas à Guerra/terapia , Humanos
16.
Implement Sci ; 14(1): 65, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217028

RESUMO

BACKGROUND: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package-Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)-on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. METHODS: We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. DISCUSSION: With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. TRIAL REGISTRATION NUMBER: ISRCTN16741720 . Registered on 2 March 2019.


Assuntos
Hospitais Públicos/organização & administração , Pacotes de Assistência ao Paciente , Assistência Perinatal/normas , Melhoria de Qualidade , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Monitorização Fisiológica/normas , Nepal , Gravidez , Ressuscitação/normas
17.
Pediatr Emerg Med Pract ; 16(5): e1-e2, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31038892

RESUMO

Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation. Care of the injured child and the effect on clinical outcomes starts in the prehospital setting, with hemorrhage control and IV fluid resuscitation. The evaluation and disposition of the patient in the ED will depend on the mechanism of injury and the severity of trauma. This issue reviews the diagnostic evaluation and management of pediatric patients with penetrating injuries to the torso. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.]


Assuntos
Ressuscitação/métodos , Tronco/lesões , Ferimentos Penetrantes/terapia , Adolescente , Criança , Pré-Escolar , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Ferimentos Penetrantes/diagnóstico
19.
Chin J Traumatol ; 22(3): 134-137, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31078422

RESUMO

PURPOSE: The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. METHODS: Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups: 'end pointed' group (n = 13), patients' BDs instantly cleared after primary hydration; 'needs further resuscitation' group (n = 21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion; and 'hydration minimal change' group (n = 9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. RESULTS: A significant reverse correlation was found between the BD ratio and the HRV ratio (r = -0.562; p = 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). CONCLUSION: Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.


Assuntos
Frequência Cardíaca , Escala de Gravidade do Ferimento , Ressuscitação , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia , Adolescente , Adulto , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Soluções Cristaloides/administração & dosagem , Hidratação , Humanos , Pessoa de Meia-Idade , Ressuscitação/métodos , Adulto Jovem
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