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Berlin Brandenburg

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  • 1
    Language: English
    In: Injury, January 2014, Vol.45(1), pp.61-65
    Description: The use of intravenous oxygen carriers (packed red blood cells (PRBC), whole blood and synthetic haemoglobins (HBOCs) for selected pre-hospital trauma resuscitation cases has been reported, despite a lack of validated clinical indications. The aim of this study was to retrospectively identify a sub-group of adult major trauma patients most likely to benefit from pre-hospital oxygen carrier administration and determine the predictive relationship between pre-hospital shock index (SI) [pulse rate/systolic blood pressure] and haemorrhagic shock, blood transfusion and mortality. A retrospective review of adult major trauma patients recorded in The Alfred Trauma Registry was conducted. Patients were included if they received at least 1 L of pre-hospital crystalloid and spent over 30 min in transit. The association of shock index and transfusion was determined. Patients were further sub-grouped by mode of transport to determine the population of trauma patients who could be included into prospective studies of intravenous oxygen carriers. There were 1149 patients included of whom 311 (21.9%) received an acute blood transfusion. The SI correlated well with transfusion practice. A SI ≥ 1.0, calculated after at least 1 L of crystalloid transfusion, identified patients with a high specificity (93.5%; 95% CI: 91.8–94.8) for receiving a blood transfusion within 4 h of hospital arrival. While patients transported by helicopter had higher injury severity and blood transfusion requirement, there were no difference in physiological variables and outcomes when compared to patients transported by road car. A shock index ≥ 1.0 is an easily calculated variable that may identify patients for inclusion into trials for pre-hospital oxygen carriers. Shocked patients have high mortality rates whether transported by road car or by helicopter. The efficacy of pre-hospital intravenous oxygen carriers should be trialled using a shock index ≥ 1.0 despite fluid resuscitation as the clinical trigger for administration.
    Keywords: Wounds and Injuries ; Emergency ; Transfusion ; Resuscitation ; Shock ; Shock Index ; Synthetic Haemoglobin ; Pre-Hospital ; Ambulance
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 2
    In: Medical Journal of Australia, December 2013, Vol.199(11), pp.807-810
    Description: To determine the incidence of patients presenting to a major metropolitan hospital after experiencing syncope at church, and to compare their outcomes with those of patients experiencing syncope at other locations. A retrospective matched cohort study in which patients presenting with church syncope between July 2009 and June 2013 were compared with controls (patients presenting after syncope experienced elsewhere) matched by 5‐year age group and San Francisco Syncope Score. Admission to hospital was the primary outcome measure. Mortality, intensive care unit or coronary care unit admission, and length of stay in hospital were secondary outcome measures. There were 31 cases of church syncope during the study period, which were matched to 62 controls. The hospital admission rate among patients who experienced syncope in church was significantly lower than among controls (22.6% v 46.8%; = 0.02). After adjusting for other variables significantly associated with admission to hospital, the church as a location for syncope was no longer significantly associated with hospital admission (odds ratio, 0.4; 95% CI, 0.1–1.1; = 0.06). The number of patients presenting to hospital after church syncope was low; most had benign diagnoses and were discharged home from the emergency department. While syncope at church was associated with a lower rate of hospital admission, the church did not appear to offer any additional sanctuary when clinical risk profiles were taken into consideration.
    Keywords: Emergency Medicine
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 3
    Language: English
    In: The Lancet, 2011, Vol.377(9771), pp.1052-1054
    Description: Unlike coagulopathy that is secondary to haemodilution, hypothermia, or acidosis, acute traumatic coagulopathy is a hyperacute process in which systemic fibrinolysis releases D-dimers that are detectable within 30 min of injury.5 While the mechanisms are poorly understood, shock and tissue injury seem...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 4
    In: Emergency Medicine Australasia, August 2013, Vol.25(4), pp.380-381
    Description: Byline: Biswadev Mitra, Peter A Cameron ***** No abstract is available for this article. *****
    Keywords: Chest Pain;
    ISSN: 1742-6731
    E-ISSN: 1742-6723
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  • 5
    Language: English
    In: Injury, 2012, Vol.43(1), pp.22-25
    Description: Acute traumatic coagulopathy is observed in 10–25% of patients post major trauma and its management forms an integral part of haemostatic resuscitation. The identification and treatment of this coagulopathy is difficult and there is uncertainty regarding optimal therapeutic guidelines during the early phases of trauma resuscitation. This study aimed to examine the association between acute coagulopathy and early deaths post major trauma. A retrospective review of data over a 5 year period was performed to determine the associations between variables considered to contribute to mortality for adult major trauma patients (Injury Severity Score (ISS) 〉 15) receiving blood transfusions as part of their initial resuscitation. Early death, defined as death in ED, or death in the operating theatre (OT), Intensive Care Unit (ICU) or wards within 24 h of admission was the primary end-point. Patients with non-survivable head injury on initial imaging were excluded. Univariate associations were calculated and multivariable logistic regression analysis was used to determine independent associations with mortality. There were 772 patients included in this study with a median ISS of 29 (19–41), with 91.7% blunt trauma. All-cause in-hospital mortality was 17.5%, while 77 (9.7%) patients died early. Increasing age (OR 1.04), a GCS of 3–8 (OR 5.05), and the presence of acute coagulopathy (OR 8.77) were significant independent variables associated with early death. Acute traumatic coagulopathy, independent of injury severity, transfusion practice or other physiological markers for haemorrhage, was associated with early death in major trauma patients requiring a blood transfusion. Early recognition and management of coagulopathy, independent of massive transfusion guidelines, may improve outcome from trauma resuscitation. Further studies are required for the early recognition of acute traumatic coagulopathy to enable the development of an evidence base for management.
    Keywords: Wounds and Injuries ; Blood Component Transfusion ; Blood Transfusion ; Emergency ; Medicine ; Resuscitation ; Medicine
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 6
    Language: English
    In: Injury, 2012, Vol.43(1), pp.33-37
    Description: A high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) is currently recognised as the standard of care in some centres during massive transfusion post trauma. The aim of this study was to test whether the presumption of benefit held true for severely injured patients who received a massive transfusion, but did not present with acute traumatic coagulopathy. Data collected in The Alfred Trauma Registry over a 6 year period were reviewed. Included patients were sub-grouped by a high FFP:PRBC ratio (≥1:2) in the first 4 h and compared to patients receiving a lower ratio. Outcomes studied were associations with mortality, hours in the intensive care unit and hours of mechanical ventilation. Of 4164 eligible patients, 374 received a massive transfusion and 179 (49.7%) patients who did not have coagulopathy were included for analysis. There were 66 patients who received a high ratio of FFP:PRBC, and were similar in demographics and presentation to 113 patients who received a lower ratio. There was no significant difference in mortality between the two groups ( = 0.80), and the FFP:PRBC ratio was not significantly associated with mortality, ICU length of stay or mechanically ventilated hours. A small proportion of major trauma patients received a massive blood transfusion in the absence of acute traumatic coagulopathy. Aggressive FFP transfusion in this group of patients was not associated with significantly improved outcomes. FFP transfusion carries inherent risks with substantial costs and the population most likely to benefit from a high FFP:PRBC ratio needs to be clearly defined.
    Keywords: Wounds and Injuries ; Blood Coagulation Disorders ; Blood Transfusion ; Resuscitation
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 7
    Language: English
    In: Injury, September 2012, Vol.43(9), pp.1409-1414
    Description: The use of recombinant factor VIIa (rFVIIa) in trauma patients is usually part of rescue therapy when haemorrhage and coagulopathy have not responded to conventional treatment. In this scenario, trauma patients are likely to have one or more components of the ‘triad of death’ (coagulopathy, acidosis and hypothermia). The aim of this study was to report on the outcome of trauma patients with the ‘triad of death’ immediately prior to receiving rFVIIa. Trauma patients receiving rFVIIa with the ‘triad of death’ were identified from the Australia and New Zealand Haemostasis Registry (ANZHR) and included in the study. The ‘triad of death’ was defined as an INR of 〉1.5, serum pH of 〈7.2 and a core temperature of 〈35 °C. Pre-dose clinical signs, investigations, adverse events and outcomes were analysed. There were 2792 patients in the ANZHR, of which 386 were trauma patients and 45 patients had the ‘triad of death’. Patients with the ‘triad of death’ were significantly older and had higher injury severity scores than other trauma patients, with a mortality of 68.9%. Survivors were significantly less acidaemic ( 〈 0.001) and had significantly less packed red blood cell (PRBC) transfusion prior to rFVIIa administration ( = 0.041) than non-survivors with the triad of death. In the face of refractory bleeding, coagulopathy, acidosis and hypothermia following conventional resuscitation, the use of rFVIIa in trauma patients was associated with survival in 31% of patients and may be considered as a management option. Administration of rFVIIa in patients with a pH of 〈6.91 appears futile.
    Keywords: Wounds and Injuries ; Factor Viia ; Hypothermia ; Acidosis ; Blood Coagulation Disorders ; Triad of Death
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 8
    Language: English
    In: The Lancet, 03 September 2016, Vol.388(10048), pp.961-962
    Description: The choice of the appropriate dose of NSAID is simple because there is a ceiling effect; lower doses are recognised to be as efficient as higher doses.2 By contrast, opioids are associated with an enormous intraindividual variability due to numerous factors, including phenotypic and genotypic characteristics.3 The consequence is that administration of a fixed dose of morphine is inappropriate because it is too much for some patients and too little for others.3 The most appropriate way to administer intravenous opioids is to titrate them according to the pain relief observed.4 Although the dose of 0·1 mg/kg of morphine is widely used in randomised trials in the emergency department,5 we think that standard care should be a titration and not a fixed dose, and we recommend that future randomised trials use titration as the standard method.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 9
    In: American Journal of Health-System Pharmacy, 2018, Vol.75(11), pp.796-806
    Description: PURPOSE: Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. SUMMARY: Emergency department (ED)–based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5–10 years. A systematic literature search covering the period 1995–2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes. Six databases were searched for research publications on pharmacist participation in patient care in a general ED or trauma center that documented interventions by ED-based pharmacists; 15 results satisfied the inclusion criteria. Six reported studies evaluated EM pharmacist involvement in the care of critically ill patients, 5 studies evaluated antimicrobial stewardship (AMS) activities via pharmacist review of positive cultures, 2 studies assessed pharmacist involvement in generating orders for nurse-administered home medications and 2 reviewed publications focused on EM pharmacist involvement in management of healthcare-associated pneumonia and dosing of phenytoin. A diverse range of positive patient outcomes was identified. The included studies were assessed to be of low quality. CONCLUSION: A systematic review of the literature revealed 3 key emerging areas of practice for the EM pharmacist that are associated with positive patient outcomes. These included involvement in management of critically ill patients, AMS roles, and ordering of home medications in the ED.
    Keywords: Emergency Medical Care ; Drug Stores ; Emergency Medical Services ; Literature Reviews ; Emergency Medical Services ; Phenytoin ; Health Care ; Patients ; Documents ; Trauma ; Literature Reviews ; Systematic Review ; Clinical Outcomes ; Medicine ; Literature Reviews ; Emergency Medicine ; Pharmacists ; Pharmacy Service Hospital ; Resuscitation ; Trauma Centers;
    ISSN: 1079-2082
    E-ISSN: 15352900
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  • 10
    Language: English
    In: Emergency Medicine Australasia, August, 2012, p.(1)
    Keywords: Preventive Medicine -- Comparative Analysis ; Thrombin -- Comparative Analysis
    ISSN: 1742-6731
    Source: Cengage Learning, Inc.
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