Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel

Pandian

Journal of Neurosciences in Rural Practice

2014

Background:The World Health Organization has estimated that globally almost 1.24 million people die annually on the world's roads. The aim of the study was to assess the attributes of pre-hospital care in road traffic accidents (RTAs) victim brought to the health care establishment and to evaluate the pre-hospital trauma care provided in the rural areas of Kancheepuram district of Tamil Nadu.Materials and Methods:A cross-sectional descriptive study of 3 months duration (June 2014 to August 2014) was conducted in the Shri Sathya Sai Medical College and Research Institute, Kancheepuram. The method of sampling was universal sampling and all RTA victims satisfying the inclusion criteria were included in the study. During the entire study duration, total 200 RTA victims were included. A pre-tested semi-structured questionnaire was used to elicit the desired information after the victims of RTAs are stabilized. Ethical clearance was obtained from the Institutional Ethics Committee prior to the start of the study. Written informed consent was obtained from the study participants (patient/guardian of children) before obtaining any information from them. Data entry and statistical analysis were done using SPSS version 18. Frequency distributions and percentages were computed for all the variables.Results:Majority of the RTA victims 158 (79%) were from the age-group of 15-45 years. Most of the accidents were reported in night time [77 (38.5%)], on week-ends [113 (56.5%)], and involved two-wheelers [153 (76.5%)]. Almost 66 (33%) of the victims were not aware of the existence of emergency ambulance services. Also, only 15 (7.5%) victims were brought to the hospital in the emergency ambulance, of which only 3 victims were accompanied by a doctor.Conclusion:To conclude, the study indicates that a significant proportion of people were unaware about the emergency trauma ambulance services and the existing pre-hospital care services lack in multiple dimensions in a rural area of South India.

“…In contrast, other studies have shown a wide range of interventions that should be done as a part of pre-hospital care to improve the outcomes. [ 34 35 ]…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital care among victims of road traffic accident in a rural area of Tamil Nadu: A cross-sectional descriptive study

Pandian

Journal of Neurosciences in Rural Practice

2014

Scand J Trauma Resusc Emerg Med

“…In another study that investigated early ABG analysis in traumatised patients, the arterial blood sample was not analysed until arrival at the hospital. Despite the fact that it investigated early ABG analysis, that study provided no additional prehospital diagnostic tools [22]. In our study, technical difficulties were experienced in obtaining ABG in a total of 22 patients (7%), including twelve patients in whom venous blood samples were erroneously drawn, eight patients in whom it was not possible to obtain a blood sample, and two patients in whom the ABL analyser failed.…”

Section: Discussionmentioning

confidence: 94%

Diagnostic value of prehospital arterial blood gas measurements – a randomised controlled trial

Zwisler

Zincuk

Bering

et al. 2019

BackgroundArterial blood gas analysis is an important diagnostic tool in managing critically ill patients within the hospital. Whether prehospital application of this diagnostic modality contributes to more exact diagnoses and treatments in critically ill prehospital patients is unknown. The aim of this study was to establish whether access to arterial blood gas analysis increased the prehospital diagnostic accuracy of prehospital anaesthesiologists. Furthermore, we investigated whether prehospital blood gas analysis resulted in therapeutic interventions that would not have been carried out if the arterial blood gas analyser had not been available.MethodsIn a prospective randomised study, two groups of prehospital adult patients with acute critical illness were compared. All patients received standard prehospital care. In the intervention group, an arterial blood gas sample was analysed prehospitally. The primary outcome was the impact of blood gas analysis on the accuracy of prehospital diagnoses. Furthermore, we registered any therapeutic interventions that were carried out as a direct result of the blood gas analysis.ResultsA total of 310 patients were included in the study. Eighty-eight of these patients were subsequently excluded, primarily due to difficulties in obtaining post hoc consent or venous sampling or other technical difficulties. A total of 102 patients was analysed in the arterial blood gas group (ABG group), while 120 patients were analysed in the standard care group (noABG group). In 78 of the 102 patients in the ABG group, the prehospital physician reported that ABG analysis increased their perceived diagnostic precision. In 81 cases in the noABG group, the lack of arterial blood gas analysis was perceived to have decreased diagnostic accuracy. The claim that ABG analysis increased diagnostic accuracy could, however, not be substantiated as there was no difference in the number of un-specific diagnoses between the groups.Blood gas analysis increased the probability of targeting specific prehospital therapeutic interventions and led to 159 interventions, including intubation, ventilation and/or upgrading the level of urgency, in 71 ABG-group patients (p < 0.001).ConclusionAlthough prehospital arterial blood gas analysis did not improve the accuracy of the prehospital diagnoses assigned to patients, it significantly increased the quality of treatment provided to patients with acute critical illness.Trial registrationClinicalTrials.gov, NCT03006692, retrospectively registered six months after first patient entry.

Acta Anaesthesiol Scand

Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician‐staffed emergency medical services: Systematic review

Tønsager

Krüger

Ringdal

et al. 2020

BackgroundEmergency physicians on‐scene provide highly specialized care to severely sick or injured patients. High‐quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p‐EMS research. This systematic review aims to describe the quality of pre‐hospital reporting of GCS and SBP data in studies where emergency physicians are present on‐scene.MethodsA systematic literature search was performed using CINAHL, Cochrane, Embase, Medline, Norart, Scopus, SweMed + and Web of Science, in accordance with the PRISMA guidelines. Reported data on accuracy of reporting, completeness and capture were extracted to describe the quality of documentation of GCS and SBP. External and internal validity assessment was performed by extracting a set of predefined variables.ResultsWe included 137 articles describing data collection for GCS, SBP or both. Most studies (81%) were conducted in Europe and 59% of studies reported trauma cases. Reporting of GCS and SBP data were not uniform and may be improved to enable comparisons. Of the predefined external and internal validity data items, 26%‐45% of data were possible to extract from the included papers.ConclusionsReporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p‐EMS.