Anesthesiologie - Urgentiegeneeskunde
  • Home
  • Updates
    • Nieuws
    • Artikel van de week
    • Tip van de week
    • Congres tips & reviews
    • Cursus Tips & Reviews
  • D-examen
  • Online Lectures
    • Resuscitation
    • Trauma
    • Airway Management
    • Prehospital Emergency Medicine
    • Crew Resource Management
    • ResusNL
  • Educatie
    • Apps
    • Podcasts
    • Blogs & Sites
    • Boeken
    • Congressen
    • Cursussen
  • Over ons

The Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only.

3/28/2015

 

Emergency Medicine Journal 2015 Mar 20.

Foto
Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care.

Read More

Advanced airway management is necessary in prehospital trauma patients 

3/23/2015

 

British Journal of Anaesthesia 114 (4): 657–62 (2015)

Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required. 

Read More

Use of single-cannula venous-venous extracorporeal life support in the management of life-threatening airway obstruction.

3/20/2015

 

Abstract
The use of venous-venous extracorporeal life support (VV ECLS) for the endoscopic management of airway obstruction has been rarely reported. In most instances, ECLS has been used in the setting of cardiopulmonary resuscitation in which venoarterial ECLS was initiated as part of resuscitation. We report a patient with a bulky primary tumor of the tracheal carina presenting with airway obstruction who was managed with intraoperative single-cannula VV ECLS to facilitate endoscopic interventions leading to more definitive airway security.

Klik hier voor de link naar pubmed

Pocket-sized focused cardiac ultrasound: Strengths and limitations.

3/14/2015

 

Arch Cardiovasc Dis. 2015 Mar 4. pii: S1875-2136(15)00010-8.

Abstract
Focused cardiac ultrasound (FCU) has emerged in recent years and has created new possibilities in the clinical assessment of patients both in and out of hospital. The increasing portability of echocardiographic devices, with some now only the size of a smartphone, has widened the spectrum of potential indications and users, from the senior cardiologist to the medical student. However, many issues still need to be addressed, especially the acknowledgment of the advantages and limitations of using such devices for FCU, and the extent of training required in this rapidly evolving field. In recent years, an increasing number of studies involving FCU have been published with variable results. This review outlines the evidence for the use of FCU with pocket-echo to address specific questions in daily clinical practice.

Foto
Klik hier voor de link naar PubMed

Fresh frozen plasma resuscitation provides neuroprotection compared to normal saline in a large animal model of traumatic brain injury and polytrauma

3/10/2015

 

J Neurotrauma. 2015 Mar 1;32(5):307-13. doi: 10.1089/neu.2014.3535.

Abstract:
We have previously shown that early treatment with fresh frozen plasma (FFP) is neuroprotective in a swine model of hemorrhagic shock (HS) and traumatic brain injury (TBI). However, it remains unknown whether this strategy would be beneficial in a more clinical polytrauma model. Yorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters, brain oxygenation, and intracranial pressure (ICP) and subjected to computer-controlled TBI and multi-system trauma (rib fracture, soft-tissue damage, and liver injury) as well as combined free and controlled hemorrhage (40% blood volume). After 2 h of shock (mean arterial pressure, 30-35 mm Hg), animals were resuscitated with normal saline (NS; 3×volume) or FFP (1×volume; n=6/group). Six hours postresuscitation, brains were harvested and lesion size and swelling were evaluated. Levels of endothelial-derived vasodilator endothelial nitric oxide synthase (eNOS) and vasoconstrictor endothelin-1 (ET-1) were also measured. FFP resuscitation was associated with reduced brain lesion size (1005.8 vs. 2081.9 mm(3); p=0.01) as well as swelling (11.5% vs. 19.4%; p=0.02). Further, FFP-resuscitated animals had higher brain oxygenation as well as cerebral perfusion pressures. Levels of cerebral eNOS were higher in the FFP-treated group (852.9 vs. 816.4 ng/mL; p=0.03), but no differences in brain levels of ET-1 were observed. Early administration of FFP is neuroprotective in a complex, large animal model of polytrauma, hemorrhage, and TBI. This is associated with a favorable brain oxygenation and cerebral perfusion pressure profile as well as higher levels of endothelial-derived vasodilator eNOS, compared to normal saline resuscitation.

Link naar het Artikel (open Acces)

Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study

3/4/2015

 

BMJ. 2015 Feb 10;350:h418.

OBJECTIVES:
To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation.
DESIGN:
Nationwide retrospective cohort study.
SETTING:
Emergency departments and paediatric intensive care units of the eight university medical centres in the Netherlands.
PARTICIPANTS:
Children aged up to 16 with cardiac arrest and hypothermia after drowning, who presented at emergency departments and/or were admitted to intensive care.
MAIN OUTCOME MEASURE:
Survival and neurological outcome one year after the drowning incident. Poor outcome was defined as death or survival in a vegetative state or with severe neurological disability (paediatric cerebral performance category (PCPC) ≥4).
RESULTS:
From 1993 to 2012, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes (98/160, median duration 60 minutes), of whom 87 (89%) died (95% confidence interval 83% to 95%; 87/98). Eleven of the 98 children survived (11%, 5% to 17%), but all had a PCPC score ≥4. In the 62 (39%) children who did not require prolonged resuscitation, 17 (27%, 16% to 38%) survived with a PCPC score ≤3 after one year: 10 (6%) had a good neurological outcome (score 1), five (3%) had mild neurological disability (score 2), and two (1%) had moderate neurological disability (score 3). From the original 160 children, only 44 were alive at one year with any outcome.
CONCLUSIONS:
Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.

Klik hier voor het artikel (open access)

    Categories

    All
    Airway Management
    Analgesia
    Bleeding
    Bloedverlies
    Brandwonden
    Cardiac Arrest
    Checklist
    CICO
    Coagulopathy
    CPR
    Cricothyrodotomy
    CRM
    Disaster Medicine
    Drugs
    ECLS
    ECMO
    ECPR
    Emergency Anesthesia
    Guideline
    Human Factors
    Hypotension
    Intubation
    Ketamine
    Military Trauma
    MTP
    Multidisciplinary
    OHCA
    Outcome
    Pediatric Resuscitation
    PHEM
    POCUS
    Prehospital
    Procedural Sedation
    Propofol
    Rapid Sequence Induction
    RCT
    Resuscitation
    Sedation
    Shock
    TBI
    Therapeutic Hypothermia
    Tranexaminezuur
    Transfusie
    Trauma
    Trauma Anesthesia
    Traumatic Brain Injury
    Trial
    TXA
    Ultrasound
    Video Laryngoscopy

    Archives

    October 2021
    August 2020
    November 2019
    October 2019
    August 2019
    January 2019
    August 2018
    July 2018
    January 2018
    December 2017
    October 2017
    September 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    September 2014
    June 2014

    RSS Feed

Anesthesiologie - Urgentiegeneeskunde
www.urgentiegeneeskunde.com



de gratis online resource over trauma-anesthesie, reanimatie, resuscitatie, airway management, prehospitale zorg en alles wat te maken heeft met de zorg voor de vitaal bedreigde patient.