Emergency Reporting offers enhanced, highly customizable Length of Service Awards Program (LOSAP) tracking tools

Emergency Reporting’s LOSAP tracking tools and reports have been enhanced to create a highly customized and user-friendly experience. Easily track and organize yearly activity such as incident and non-incident, event and committee attendance.

from EMS via xlomafota13 on Inoreader http://ift.tt/2Gh6o0k

New product announcement: Public Access Quiklitter

SALIDA, Colo. — The new Rescue Essentials Public Access QuikLitter™ was designed specifically to be a more visible and easily accessible casualty extraction litter placed in public places, such as commercial buildings, entertainment venues, or transportation hubs. The Public Access Quiklitter, is intended to complement existing public access to AED and bleeding control stations and can be ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2DzJAHq

Selective nonoperative management of liver gunshot injuries

Abstract

Purpose

Nonoperative management (NOM) of gunshot liver injuries (GLI) is infrequently practiced. The aim of this study was to assess the safety of selective NOM of GLI.

Methods

A prospective, protocol-driven study, which included patients with GLI admitted to a level 1 trauma center, was conducted over a 52-month period. Stable patients without peritonism or sustained hypotension with right-sided thoracoabdominal (RTA) and right upper quadrant (RUQ), penetrating wounds with or without localized RUQ tenderness, underwent contrasted abdominal CT scan to determine the trajectory and organ injury. Patients with established liver and/or kidney injuries, without the evidence of hollow viscus injury, were observed with serial clinical examinations. Outcome parameters included the need for delayed laparotomy, complications, the length of hospital stay and survival.

Results

During the study period, 54 (28.3%) patients of a cohort of 191 patients with GLI were selected for NOM of hemodynamic stability, the absence of peritonism and CT imaging. The average Revised Trauma Score (RTS) and Injury Severity Score (ISS) were 7.841 and 25 (range 4–50), respectively. 21 (39%) patients had simple (Grades I and II) and 33 (61%) patients sustained complex (Grades III to V) liver injuries. Accompanying injuries included 12 (22.2%) kidney, 43 (79.6%) diaphragm, 20 (37.0%) pulmonary contusion, 38 (70.4%) hemothoraces, and 24 (44.4%) rib fractures. Three patients required delayed laparotomy resulting in an overall success of NOM of 94.4%. Complications included: liver abscess (1), biliary fistula (5), intrahepatic A-V fistula (1) and hospital-acquired pneumonia (3). The overall median hospital stay was 6 (IQR 4–11) days, with no deaths.

Conclusion

The NOM of carefully selected patients with GLI is safe and associated with minimal morbidity.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2DBUsZf

NH EMS agency honors volunteer for 45 years of service

By Deborah McDermott Portsmouth Herald YORK, N.H. — Forty-five years ago, Mary Andrews was chief of a three-person crew on the very first ambulance owned by the fledgling York Volunteer Ambulance Association. It was stored in her garage, with a heater inside to keep the oxygen warm powered by a yellow electrical cord that snaked inside her house - and that sometimes inadvertently went on rides ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2DBM8c2

Radiological classification of retroperitoneal hematoma resulting from lumbar vertebral fracture

Abstract

Purpose

Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF.

Methods

For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes.

Results

RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication.

Conclusions

LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2n9dcEq

Prompt Administration of Antibiotics and Fluids in the Treatment of Sepsis: A Murine Trial

Objectives: Sepsis, the acute organ dysfunction caused by a dysregulated host response to infection, poses a serious public health burden. Current management includes early detection, initiation of antibiotics and fluids, and source control as necessary. Although observational data suggest that delays of even a few hours in the initiation of antibiotics or IV fluids is associated with survival, these findings are controversial. There are no randomized data in humans, and prior animal studies studied time from experimental manipulation, not from the onset of clinical features of sepsis. Using a recently developed murine cecal ligation and puncture model that precisely monitors physiologic deterioration, we hypothesize that incremental hourly delays in the first dose of antibiotics, in the first bolus of fluid resuscitation, or a combination of the two at a clinically relevant point of physiologic deterioration during polymicrobial sepsis will shorten survival. Design: Randomized laboratory animal experimental trial. Setting: University basic science laboratory. Subjects: Male C57BL/6J, female C57BL/6J, aged (40–50 wk old) male C57BL/6J, and BALB/C mice. Interventions: Mice (n = 200) underwent biotelemetry-enhanced cecal ligation and puncture and were randomized after meeting validated criteria for acute physiologic deterioration. Treatment groups consisted of a single dose of imipenem/cilastatin, a single bolus of 30 mL/kg fluid resuscitation, or a combination of the two. Mice were allocated to receive treatment at the time of meeting deterioration criteria, after a 2-hour delay or after a 4-hour delay. Measurements and Main Results: Hourly delays in the initiation of antibiotic therapy led to progressively shortened survival in our model (p

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2n6Zyma

Clinical Epidemiology of Adults With Moderate Traumatic Brain Injury

Objectives: To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury. Design: Retrospective cohort study. Setting: National Trauma Data Bank. Patients: Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9–13) in the National Trauma Data Bank between 2007 and 2014. Interventions: None. Measurement and Main Results: Demographics, mechanism of injury, hospital course, and facility characteristics were examined. Admission characteristics associated with discharge outcomes were analyzed using multivariable Poisson regression models. Of 114,066 patients, most were white (62%), male (69%), and had median admission Glasgow Coma Scale score of 12 (interquartile range, 10–13). Seventy-seven percent had isolated traumatic brain injury. Concussion, which accounted for 25% of moderate traumatic brain injury, was the most frequent traumatic brain injury diagnosis. Fourteen percent received mechanical ventilation, and 66% were admitted to ICU. Over 50% received care at a community hospital. Seven percent died, and 32% had a poor outcome, including those with Glasgow Coma Scale score of 13. Compared with patients 18–44 years, patients 45–64 years were twice as likely (adjusted relative risk, 1.97; 95% CI, 1.92–2.02) and patients over 80 years were five times as likely (adjusted relative risk, 4.66; 95% CI, 4.55–4.76) to have a poor outcome. Patients with a poor discharge outcome were more likely to have had hypotension at admission (adjusted relative risk, 1.10; 95% CI, 1.06–1.14), lower admission Glasgow Coma Scale (adjusted relative risk, 1.37; 95% CI, 1.34–1.40), higher Injury Severity Score (adjusted relative risk, 2.97; 95% CI, 2.86–3.09), and polytrauma (adjusted relative risk, 1.05; 95% CI, 1.02–1.07), compared with those without poor discharge outcomes. Conclusions: Many patients with moderate traumatic brain injury deteriorate, require neurocritical care, and experience poor outcomes. Optimization of care and outcomes for this vulnerable group of patients are urgently needed. This study was conducted at Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/29S62lw). Dr. Lele’s institution received funding from the National Institutes of Health (NIH). Dr. Vavilala received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: arrayawat@gmail.com Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2Bqrcyt