ABSTRACT
Estimates of clinically relevant information, such as height, weight, blood loss, and burn area, have consistently been fraught with error in the health care setting. Seemingly little has been done in health care education to improve estimate outcomes. Standardized tools, most often in pediatric populations, have become commonplace to guide acute care management when misestimation of data points like height or weight would likely have its biggest impact on patient care and outcome. This article is a retrospective study of a critical care transport team's abilities to estimate patient height and weight in scene responses using the Glasgow Coma Scale score as an indicator for the likelihood of patient input. Ultimately, height was removed as a variable because of the paucity and unreliability of the collected data. The expected outcome with respect to weight estimates was observed; with decreased patient Glasgow Coma Scale scores, the discrepancy in provider estimate increased from 8% to 12%. Although statistically significant, it does not represent the level of aberrancy noted in other studies, which has been reported to be as high as 40%.
Subject(s)
Body Weights and Measures , Critical Care , Emergency Medical Technicians , Professional Competence/standards , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Retrospective Studies , Transportation of PatientsSubject(s)
Angioedema/therapy , Transportation of Patients , Aged , Angioedema/diagnosis , Angioedema/pathology , Emergency Service, Hospital , Humans , MaleSubject(s)
Contusions/complications , Extracorporeal Membrane Oxygenation , Lung Injury/complications , Respiratory Distress Syndrome/therapy , Accidents, Traffic , Adult , Air Ambulances , Contusions/diagnosis , Humans , Lung Injury/diagnosis , Male , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiologySubject(s)
Compartment Syndromes/diagnosis , Emergency Medical Services/methods , Orbit/injuries , Orbital Diseases/diagnosis , Tendons/surgery , Compartment Syndromes/diagnostic imaging , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Female , Humans , Male , Middle Aged , Orbit/diagnostic imaging , Orbit/surgery , Orbital Diseases/diagnostic imaging , Orbital Diseases/etiology , Orbital Diseases/surgery , Tomography, X-Ray Computed , Young AdultSubject(s)
Air Ambulances , Blast Injuries/diagnostic imaging , Explosions , Multiple Trauma/diagnostic imaging , Abdominal Injuries/diagnostic imaging , Blast Injuries/therapy , Burns/therapy , Child , Contusions/diagnostic imaging , Femoral Fractures/diagnostic imaging , Femoral Fractures/surgery , Fibula/diagnostic imaging , Fibula/injuries , Fibula/surgery , Fractures, Bone , Fractures, Open/diagnostic imaging , Fractures, Open/surgery , Humans , Intubation, Intratracheal , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/injuries , Lung Injury/diagnostic imaging , Male , Multiple Trauma/therapy , Pneumoperitoneum/diagnostic imaging , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , Spinal Fractures/diagnostic imaging , Spinal Fractures/surgery , Spleen/injuries , Tibial Fractures/diagnostic imaging , Tibial Fractures/surgery , Tomography, X-Ray ComputedSubject(s)
Ankle Fractures/diagnostic imaging , Aviation , Joint Dislocations/diagnostic imaging , Spinal Cord Injuries/diagnostic imaging , Spinal Fractures/diagnostic imaging , Air Ambulances , Ankle Fractures/complications , Ankle Fractures/surgery , Ankle Injuries/complications , Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Decompression, Surgical , Foot Bones/injuries , Fracture Fixation, Internal , Fractures, Bone/complications , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Humans , Joint Dislocations/complications , Joint Dislocations/surgery , Lumbar Vertebrae/injuries , Male , Middle Aged , Open Fracture Reduction , Patient Transfer , Radiography , Spinal Cord Injuries/etiology , Spinal Cord Injuries/surgery , Spinal Fractures/complications , Spinal Fractures/surgery , Spinal Fusion , Tomography, X-Ray ComputedSubject(s)
Accidents, Traffic , Air Ambulances , Craniocerebral Trauma/therapy , Hematoma, Epidural, Cranial/therapy , Adolescent , Craniocerebral Trauma/diagnostic imaging , Craniotomy , Glasgow Coma Scale , Hematoma, Epidural, Cranial/diagnostic imaging , Humans , Intubation, Intratracheal , Male , Respiration, Artificial/methods , Tomography, X-Ray ComputedSubject(s)
Air Ambulances , Facial Injuries/therapy , Wounds, Gunshot/therapy , Facial Injuries/diagnostic imaging , Facial Injuries/etiology , Facial Injuries/surgery , Humans , Intubation, Intratracheal , Male , Middle Aged , Plastic Surgery Procedures , Tomography, X-Ray Computed , Wounds, Gunshot/diagnostic imaging , Wounds, Gunshot/surgeryABSTRACT
Hemorrhagic shock from trauma is a leading cause of morbidity and mortality and commonly encountered by HEMS agencies. Understanding of the management of patients in hemorrhagic shock transported from the scene and interfacility transfers is important for all critical care providers.
Subject(s)
Accidents, Traffic , Air Ambulances , Multiple Trauma , Shock, Hemorrhagic , Brain Injuries, Traumatic , Fractures, Comminuted/diagnostic imaging , Hemothorax/diagnostic imaging , Hemothorax/therapy , Humans , Intubation, Intratracheal , Lacerations/diagnostic imaging , Lung Injury/diagnostic imaging , Male , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , Spinal Fractures/diagnostic imaging , Subarachnoid Hemorrhage, Traumatic , Thoracic Vertebrae/diagnostic imaging , Thoracostomy , Young AdultSubject(s)
Acetaminophen/poisoning , Analgesics, Opioid/poisoning , Drug Overdose/complications , Hydrocodone/poisoning , Respiratory Insufficiency/chemically induced , Adolescent , Air Ambulances , Drug Combinations , Drug Overdose/etiology , Drug Overdose/therapy , Extracorporeal Membrane Oxygenation , Female , Humans , Patient Transfer , Respiration, Artificial , Respiratory Insufficiency/therapySubject(s)
Air Ambulances , Fibrinolytic Agents/therapeutic use , Infarction, Middle Cerebral Artery/therapy , Thrombectomy , Tissue Plasminogen Activator/therapeutic use , Aged , Cerebral Angiography , Humans , Infarction, Middle Cerebral Artery/diagnostic imaging , Male , Patient Transfer , Thrombolytic Therapy/methods , Tomography, X-Ray ComputedABSTRACT
Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08.