Introduction. Agriculture is an industry where family members often live and work on the same premises. This study evaluated injury patterns and outcomes in children from farm-related accidents. Methods.A 10-year retrospective review of farm-accident related injuries was conducted of patients 17 years and younger. Data collected included demographics, injury mechanism, accident details, injury severity and patterns, treatments required, hospitalization details, and discharge disposition.Results. Sixty-five patients were included; 58.5% were male and the mean age was 9.7 years. Median Injury Severity Score and Glasgow Coma Scale were 5 and 15, respectively. Accident mechanisms included animal-related (43.1%), fall (21.5%), and motor vehicle (21.5%). Soft tissue injuries, concussions and upper extremity fractures were the most common injuries observed (58.5%, 29.2%, and 26.2%, respectively). Twenty-six patients (40%) required surgical intervention. Mean hospital length of stay was 3.4 ± 4.7 days. The majority of patients were discharged to home (n = 62, 95.4%) and two patients suffered permanent disability. Conclusion.Overall, outcomes for this population were favorable, but additional measures to increase safety, such as fall prevention, animal handling, and driver safety training should be advocated. Med 2017;10(4):92-95. KS J
Background: Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF) of different causes. The Chilean Ministry of Health started in 2006 a program for HMV in Children and in 2008 it began a program for HMV in adults. All belonged to the state health insurance.Methods: Prospective cohort of adult patients with CRF in 10 regions of Chile admitted to the national HMV program, their demographic, clinical and functional characteristics, mode of admission, time in the program and survival.Results: A total of 1,105 patients were included. Median age was 59 years (44-58, IQR1-IQR3). Women were 58.1%. The body mass index was 34.9 (26-46) kg/m2, and 942 (85.4%) belonged to low-income socioeconomic groups. The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (35-62.1) points, 98.5% lived in urban areas, 76.2% initiated HMV in the stable chronic mode, 23.8% in the acute mode and 99 patients were transferred from the children's program. There were 1047 patients on noninvasive ventilation and 58 on invasive ventilation through tracheostomy. Baseline PaCO2 was 58.2 (52-65) mmHg. Device usage time was 7.3 h/d (5.8-8.8), the time in HMV was 21.6 (12.2-49.5) months. The diagnostic groups were COPD, 35%; obesity hypoventilation syndrome (OHS), 23.9%; neuromuscular disease (NMD) 16.3%; non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC) 8.3%; Scoliosis, 5.9%; and Amyotrophic Lateral Sclerosis (ALS) 5.24%. The lowest 1- and 3-year survival rates were observed in the ALS group, i.e., 67% and 26%, respectively, and the lowest 9-year survival was observed in the non-CF BC or TB and COPD, 27% and 30.9%, respectively. The best survival rates at 9 years were 57.7%, 57.2% and 50.9% for patients with OHS, Scoliosis and NMD, respectively.Conclusion: The most common diagnoses were COPD and OHS. Patients were hypercapnic and had poor quality of life at program admission. The best survival was observed in patients with OHS, Scoliosis and NMD.
Patient refusal for care or transport is a common request to medical control physicians, and it is an especially challenging decision in the case of minors. Parents or guardians are able to refuse medical care for a minor if there is not an imminent threat of harm to the minor. However, if a minor patient is presumed to be in need of emergent medical care to prevent harm, medical personnel have the right to treat the minor, even if the parent or guardian objects. If the minor patient is a fetus or a neonate, it is not always clear when they are considered to be a separate patient. Apparently, there is no over-riding general rule or law and, consequently, Emergency Medical Services (EMS) protocols vary greatly from state to state. This case report describes one patient case that involved some of these unclear legal areas and how it fit with local EMS protocols. The legal question arose when a pregnant patient delivered her baby, but the umbilical cord was not cut. Are the mother’s rights violated by cutting the umbilical cord if she objects to the procedure? How is the medical control physician to decide when to go beyond established EMS protocols to ensure that the safest and most ethical care is provided to a patient in the field? Does the care of the infant or the mother take precedence? Continued analyses of cases are required to ensure that protocols and guidelines are protecting both patients and providers.Venegas A, Ann Maggiore W, Wells R, Baker R, Watts S. Medical control decisions: when does a neonate become a separate patient? Prehosp Disaster Med. 2019;34(2):224–225
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