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13 results

  • 53 - Soft Tissue Injury

  • from Section 11 - Trauma
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 567-577

  • Summary

    • Severe crush injury can result in sequelae such as significant bony fractures, rhabdomyolysis, extremity compartment syndrome or crush syndrome. Crush syndrome comprises the systemic manifestations that arise as a result of a crush injury followed by reperfusion. From the rupture of muscle cells, substances such as myoglobin, potassium, phosphorus and creatinine phosphokinase are released into the bloodstream. The patient can subsequently develop hyperkalemia, hypocalcemia, hypovolemia, shock, compartment syndrome, lactic acidosis or renal failure from traumatic rhabdomyolysis (seen in up to 40% of patients with crush injury).

  • 54 - Burn Resuscitation

  • from Section 11 - Trauma
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 578-588

  • Summary

    • Two-thirds of reported burn cases admitted to burn centers affect less than 10% of total body surface area (TBSA) and require a relatively short hospitalization. The majority of patients with major burn injury or significant physiological derangements survive. Improvement in mortality rates is related to advances in resuscitation, infection control, modulation of the hypermetabolic response to traumatic injury and early excision and grafting. Traditional classification of burns of first, second, third and fourth degree have been replaced by a more descriptive explanation of injury depth:

  • 9.5 - Paediatric Sepsis

  • from Section 9 - Paediatric Care
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 703-707

  • Summary

    Key Learning Points

    1. 1. Sepsis remains a major cause of death in the paediatric population.

    2. 2. Mortality is higher in children with co-morbidities than in those without.

    3. 3. Volume resuscitation is still the mainstay of initial resuscitation.

    4. 4. Adrenaline is a rational choice as a first-line vasoactive agent.

    5. 5. Combining clinical examination with plasma lactate can be used to guide resuscitation.

  • Helicopter In-flight Resuscitation with Freeze-dried Plasma of a Patient with a High-velocity Gunshot Wound to the Neck in Afghanistan – A Case Report

  • Mikael Gellerfors, Joacim Linde, Dan Gryth
  • Journal:
    Prehospital and Disaster Medicine / Volume 30 / Issue 5 / October 2015
    Published online by Cambridge University Press:
    01 September 2015, pp. 509-511
    Print publication:
    October 2015

  • Massive hemorrhage with coagulopathy is one of the leading causes of preventable death in the battlefield. The development of freeze-dried plasma (FDP) allows for early treatment with coagulation-optimizing resuscitation fluid in the prehospital setting. This report describes the first prehospital use of FDP in a patient with carotid artery injury due to a high-velocity gunshot wound (HVGSW) to the neck. It also describes in-flight constitution and administration of FDP in a Medevac Helicopter. Early administration of FDP may contribute to hemodynamic stabilization and reduction in trauma-induced coagulopathy and acidosis. However, large-scale studies are needed to define the prehospital use of FDP and other blood products.

    Gellerfors M, Linde J, Gryth D. Helicopter In-flight Resuscitation with Freeze-dried Plasma of a Patient with a High-velocity Gunshot Wound to the Neck in Afghanistan – A Case Report. Prehosp Disaster Med. 2015;30(5):509–511.

  • Short-term renal support in postoperative repair of tetralogy of Fallot in the paediatric intensive care unit: can we predict those who need it?

  • Michael J. Griksaitis, Rebekah R. Kemp, Robert J. Dyer, James P. Gnanapragasam, Nicola Viola, Iain Macintosh, Kim Sykes
  • Journal:
    Cardiology in the Young / Volume 25 / Issue 4 / April 2015
    Published online by Cambridge University Press:
    10 June 2014, pp. 760-764
  • Introduction

    Fluid balance and renal function can be difficult to manage in the postoperative infant with tetralogy of Fallot. High fluid volumes are often needed to maintain cardiac output.

    Aims

    To stratify patients at risk for advanced renal support following tetralogy of Fallot repair.

    Methods

    Retrospective analysis of all consecutive tetralogy of Fallot cases operated at a single centre in a 3-year period.

    Results

    A total of 41 children were identified. All cases had loop diuretics administered. Of the cases, 17% required support with a peritoneal dialysis catheter, with only one complication of peritoneal dialysis catheter blockage. The mean length of paediatric intensive care unit stay in those receiving peritoneal dialysis catheter insertion was prolonged by an additional mean of 6 days (p<0.001). No statistical significance was found between those children requiring peritoneal dialysis and those who did not when considering patient age and weight at time of repair, cardiopulmonary bypass and aortic cross clamp times, the presence of a transannular patch, or junctional ectopic tachycardia. However, volume requirement of more than 35 ml/kg in the first 12 hours following repair did increase the likelihood to need peritoneal dialysis (p<0.0001). Furthermore, the higher the peak creatinine, the longer the stay on intensive care (p<0.01).

    Conclusions

    Peritoneal dialysis is an effective method of dealing with fluid balance in children after tetralogy of Fallot repair, with minimal complications. Early consideration should be given to peritoneal dialysis when it is clear that high fluid volumes are required postoperatively.

  • Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

  • Olanrewaju A. Soremekun, Melissa L. Shear, Jay Connolly, Charles E. Stewart, Stephen H. Thomas
  • Journal:
    Prehospital and Disaster Medicine / Volume 27 / Issue 3 / June 2012
    Published online by Cambridge University Press:
    05 July 2012, pp. 220-225
    Print publication:
    June 2012
  • Introduction

    During disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.

    Objectives

    The objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).

    Methods

    Eighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.

    Results

    In all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).

    Conclusions

    The use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.

    Soremekun OA, Shear ML, Connolly J, Stewart CE, Thomas SH. Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access. Prehosp Disaster Med. 2012;27(3):1-6.

  • Chapter 47 - Core areas required for UK/European Diploma examinations

  • from Section IV: - Examinations
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 369-373

  • Summary

    Paracetamol poisoning is the most common cause of acute liver failure (ALF) in Western Europe, Australia and USA. The N-acetyl derivative of the amino acid cysteine (NAC) serves as a precursor to the production of glutathione and is the treatment of choice in early paracetamol toxicity. Patients with hyperacute or acute liver failure often require significant volumes of fluid resuscitation. Patients with liver failure are prone to hypoglycaemia. Liver failure leads to a loss of synthetic function of hepatocytes and reduction of coagulation factors, and international normalized ratio (INR) is a very important prognostic factor. The complications of liver failure include hepatic encephalopathy, intracranial hypertension, renal failure and adrenal dysfunction. In a selected group of patients liver transplantation is the treatment of choice. Overall survival, without transplantation, is about 40% following the onset of ALF. Acute on chronic liver failure represents the decompensation of otherwise stable chronic liver disease.

  • 7 - Pre-eclampsia and hypertensive disorders of pregnancy

    • By Egidio da Silva, Specialist Registrar in Anaesthesia and Intensive care University Hospitals, Birmingham, Queen Elizabeth Hospital, Birmingham, UK, Wilson Chimbira, Lecturer in Anaesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  • Alexander Heazell, University of Manchester, John Clift
  • Book:
    Obstetrics for Anaesthetists
    Published online:
    21 August 2009
    Print publication:
    06 March 2008, pp 70-87

  • Summary

    Success in the management of pre-eclampsia is partly dependent on a multidisciplinary approach by the midwifery, obstetric, anaesthetic, intensive care and neonatal teams. Fetal complications of pre-eclampsia also result from placental dysfunction, and may be acute or chronic. The presentation of chronic pathology depends on the duration and severity of the changes to the placenta, but may include intra-uterine growth restriction (IUGR), which may ultimately lead to intra-uterine fetal death (IUFD). An accurate clinical assessment of patients with hypertension and/or pre-eclampsia is essential as the clinical course, and subsequent management is different for women with pregnancy-induced hypertension, pre-eclampsia and severe preeclampsia. Maintenance of fluid balance is essential in the management of severe pre-eclampsia, to prevent iatrogenic pulmonary oedema due to fluid overload. Hypotension occurring during Caesarean section or following regional anaesthesia is treated by careful fluid resuscitation. Women with severe pre-eclampsia and eclampsia require close monitoring after delivery.

  • Transfusion Therapy During War and Peace in Sarajevo

  • Mirza Begovic, Abdulah Kozlicic
  • Journal:
    Prehospital and Disaster Medicine / Volume 9 / Issue S1 / June 1994
    Published online by Cambridge University Press:
    28 June 2012, pp. S16-S19
    Print publication:
    June 1994
  • Objective:

    To investigate surgical blood usage during the siege of Sarajevo.

    Methods:

    Data on blood usage and pre-transfusion hematocrit (Hct) values from blood transfusion request forms in 250 wartime emergency surgical procedures during August through October 1992 (experimental group), and in 146 peacetime elective surgical procedures (control group) during April through June 1991 at the State Hospital of Sarajevo, were reviewed.

    Results:

    The mean number of blood units transfused per patient (blood usage rate) was 1.13 in the experimental group versus 2.56 in the control group (p <0.001). During the war, for blood conservation, normovolemic hemodilution was practiced widely. A significantly lower mean pre-transfusion Hct value of 0.21 was observed in the experimental group versus 0.27 in the control group (p <0.001).

    Conclusion:

    Blood-usage rate was lower during emergency surgical procedures in war than during elective surgical procedures in peacetime without apparent adverse patient outcome. This decrease in blood-usage rate in the face of increased numbers of trauma victims was the result of a planned blood-conservation program which included: stringent blood-usage criteria, and widespread implementation of casualty resuscitation using normovolemic hemodilution with colloid and crystalloid plasma substitutes.