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Injuries Due to Burns and Cold
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
If intubation is required, senior anaesthetic help is necessary and an uncut endotracheal tube should be used as subsequent facial swelling may cause the connectors to oxygen tubing to disappear into the oropharynx. Intravenous access with two large-bore cannulae is ideal, avoiding cannulation through burnt skin if possible. Alternatives include intravenous cut-down, intraosseous infusion or central routes including the femoral vein. Blood must be sent for laboratory baseline investigations including carboxyhaemoglobin levels if inhalation injury is suspected. An initial carboxyhaemoglobin level can be established from an arterial blood gas analysis.
Pre-hospital care
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
We shall assume that the reader has a background of basic and advanced medical emergency techniques, so such procedures as tracheal intubation or intraosseous infusion will not be described in detail. Readers may refer to other specific medical textbooks to obtain more information on the various medical emergency techniques if necessary.
Resuscitation Physiology
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Intraosseous infusion is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the venous system. This technique is used in emergency and military situations to provide fluids and medication when intravenous access is not feasible. A comparison of intravenous, intramuscular, and intraosseous routes of administration concluded that in children, the intraosseous route is demonstrably superior to the intramuscular route, and comparable to the intravenous route.17
Neighborhood Poverty and 9-1-1 Ambulance Response Time
Published in Prehospital Emergency Care, 2018
Josh Seim, Melody J. Glenn, Joshua English, Karl Sporer
Previous scholarship on critical and non-critical EMS interventions inspired our decision to also calculate tract-level MART for high severity, medium severity, and low severity ambulance contacts (2, 13). Where the MPDS categories helped us estimate predicted severity, the intervention-determined severities helped us estimate actual severity. The intuition was that numerous responses were likely “mistriaged” by dispatch and accounting for a retrospective measure of severity would offer a simple robustness check. For the purposes of this study, high severity contacts included ambulance encounters that involved one or more of the following interventions: Adenosine, Albuterol, Amiodarone, Atropine, Atrovent, bag valve mask, bronchodilators, calcium chloride, cardioversion, chest seal, continuous positive airway pressure, cardiopulmonary resuscitation (manual or auto), defibrillation, dextrose, dopamine, endotracheal intubation, epinephrine, glucagon, intraosseous infusion, King supraglottic airway, naloxone, nasopharyngeal airway, needle decompression, oropharyngeal airway, Pralidoxime (2-PAM), return of spontaneous circulation, sodium bicarbonate, sodium thiosulfate, ST-elevation myocardial infarction alert, stroke alert, suction, tourniquet, transcutaneous pacing, trauma activation, or Versed. Medium severity contacts included encounters that did not involve the previously listed interventions but included one or more of the following: aspirin, Benadryl, bleeding control, fentanyl, fluid bolus, glucose paste, nitroglycerin, oxygen (high flow), sepsis alert, spinal motion restriction (collar-only or full), splinting (traction and non-traction), vagal maneuver, or Zofran. Low severity contacts captured encounters that did not include high or medium severity interventions and usually did not include any medical interventions beyond an electrocardiogram, an intravenous lock, an icepack, low-flow oxygen, or a transport to the hospital. While coding for all three levels of severity, we dropped 69 cases where paramedics determined death in the field where neither high nor medium level interventions were performed. We recognize that distinctions in “high,” “medium,” and “low” severity interventions are complicated and worthy of debate, but we were simply interested in determining whether the association between tract-level poverty and MART was generally robust to specifications in intervention severity.