HEMS vs GEMS discusses the differences between helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) for transporting trauma patients. Patients transported by HEMS tend to be more severely injured and HEMS is able to complete more advanced prehospital procedures. However, HEMS also has longer on-scene and transport times. The evidence on whether HEMS improves survival rates compared to GEMS is inconclusive, with some studies finding a benefit and others not. Overall, the presentation examines the tradeoffs between HEMS and GEMS across factors like speed, patient severity, prehospital treatment capabilities, and survival outcomes.
This is a slightly updated version of a previous lecture on the science behind CPR. I have deleted the older version to avoid confusion, though they are both essentially the same
This lecture is good for first responders of all levels (from lifegaurds to paramedics) to really bring home the importance of CPR. It has been my experiance that current CPR classess are lacking in this regard, therefore compliance with new CPR standards is lacking, and this promotes LAZY CPR. This is my attempt to remedy that issue.
This document discusses the roles and responsibilities of EMTs at incidents involving hazardous materials or multiple casualties. It provides guidance on incident command structure, triage protocols, hazardous material identification, and training requirements for responding to hazmat emergencies. Key topics covered include establishing command and triage sectors at an MCI, using START triage to prioritize patients, identifying hazmat from placards and shipping documents, and ensuring proper decontamination of patients before transport.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
The document discusses disaster triage methods for mass casualty incidents with limited resources. It describes the START and SAVE triage protocols. START (Simple Triage and Rapid Treatment) uses respiratory rate, pulse, and mental status to categorize patients as red, yellow, green, or black. SAVE (Secondary Assessment of Victim Endpoint) further assesses patients in a priority order determined by START to allocate limited treatment resources to those with the highest survival probability. The document provides examples of applying both START and SAVE triage protocols to different disaster patients.
Preventing falls in the SNF environment can be a challenge. Learn how to become a fall CSI and inspire your interdisciplinary team to meet the challenge of Falls Reduction. Improve patient care and survey outcomes.
1. Learn to detail the Benefit of Root Cause analysis.
2. Gain an understanding of the Fall Investigation process.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn how to verbalize the benefit of interdisciplinary involvement and follow-up for Fall Events.
The document discusses emergency department (ED) overcrowding as a significant problem that acts as a barrier to timely emergency care. It defines ED overcrowding and identifies its causes as related to factors affecting patient inflow, throughput within the ED, and output/discharge from the ED. Potential solutions discussed include increasing ED resources, using observation units, fast tracks, improving bed access and management, and coordinating efforts across the healthcare system rather than focusing solutions solely within the ED.
1) Hesiod's Theogony tells the Greek creation story of how the universe, gods, and mankind came into existence. It describes a world where the gods are natural forces that evolved from primordial entities like Chaos.
2) In the beginning there was Chaos, from which emerged Tartarus, Erebus, Night, and later Gaea (Earth). Gaea gave birth to Uranus (Sky) and their offspring, including the Titans.
3) Cronus castrated his father Uranus with a sickle. From Uranus' blood came the Furies and Giants, and from his semen in the sea came Aphrodite. Cronus then over
This is a slightly updated version of a previous lecture on the science behind CPR. I have deleted the older version to avoid confusion, though they are both essentially the same
This lecture is good for first responders of all levels (from lifegaurds to paramedics) to really bring home the importance of CPR. It has been my experiance that current CPR classess are lacking in this regard, therefore compliance with new CPR standards is lacking, and this promotes LAZY CPR. This is my attempt to remedy that issue.
This document discusses the roles and responsibilities of EMTs at incidents involving hazardous materials or multiple casualties. It provides guidance on incident command structure, triage protocols, hazardous material identification, and training requirements for responding to hazmat emergencies. Key topics covered include establishing command and triage sectors at an MCI, using START triage to prioritize patients, identifying hazmat from placards and shipping documents, and ensuring proper decontamination of patients before transport.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
The document discusses disaster triage methods for mass casualty incidents with limited resources. It describes the START and SAVE triage protocols. START (Simple Triage and Rapid Treatment) uses respiratory rate, pulse, and mental status to categorize patients as red, yellow, green, or black. SAVE (Secondary Assessment of Victim Endpoint) further assesses patients in a priority order determined by START to allocate limited treatment resources to those with the highest survival probability. The document provides examples of applying both START and SAVE triage protocols to different disaster patients.
Preventing falls in the SNF environment can be a challenge. Learn how to become a fall CSI and inspire your interdisciplinary team to meet the challenge of Falls Reduction. Improve patient care and survey outcomes.
1. Learn to detail the Benefit of Root Cause analysis.
2. Gain an understanding of the Fall Investigation process.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn how to verbalize the benefit of interdisciplinary involvement and follow-up for Fall Events.
The document discusses emergency department (ED) overcrowding as a significant problem that acts as a barrier to timely emergency care. It defines ED overcrowding and identifies its causes as related to factors affecting patient inflow, throughput within the ED, and output/discharge from the ED. Potential solutions discussed include increasing ED resources, using observation units, fast tracks, improving bed access and management, and coordinating efforts across the healthcare system rather than focusing solutions solely within the ED.
1) Hesiod's Theogony tells the Greek creation story of how the universe, gods, and mankind came into existence. It describes a world where the gods are natural forces that evolved from primordial entities like Chaos.
2) In the beginning there was Chaos, from which emerged Tartarus, Erebus, Night, and later Gaea (Earth). Gaea gave birth to Uranus (Sky) and their offspring, including the Titans.
3) Cronus castrated his father Uranus with a sickle. From Uranus' blood came the Furies and Giants, and from his semen in the sea came Aphrodite. Cronus then over
1. The Greek creation myth describes the origins of the universe from primordial deities Ouranos and Gaia. Their offspring included the Hecatonchires, Cyclopes, and Titans like Kronos.
2. Kronos castrated his father Ouranos and became the new ruler, but was destined to be overthrown by his own son. He ate his children to avoid this fate until Zeus was saved.
3. Zeus then overthrew Kronos and became the ruler of Mount Olympus and the gods. He created four races of humans and furnished the earth with life and animals.
Physical therapy can help with recovery from injuries and encourage an active lifestyle by working muscles. The field evolved from events like polio epidemics and wars. Physical therapists must be licensed and typically earn a graduate or doctoral degree. Their duties include assessing patients, developing care plans, and educating on recovery. While the work helps others, it requires extensive schooling and risks burnout from the human services field. Therapists use tools like goniometers, ultrasound, resistance bands and treatment tables.
The document summarizes the plot of the play Antigone by Sophocles. It describes how Antigone defies King Creon's edict by burying her brother Polynices, who was killed in battle against their city of Thebes. Creon sentences Antigone to death, leading to the tragic suicides of Antigone, Creon's son Haemon, and his wife Eurydice due to Creon's stubbornness and refusal to listen to wise counsel.
The document provides an overview of Homer's epic poem The Iliad, including details about its author, type of work, characters, plot, themes, and other literary elements. It was written in ancient Greece around 750 BC and focuses on the Trojan War, particularly the quarrel between Achilles and Agamemnon and its consequences. The summary highlights the major conflict between Achilles and Agamemnon, the rising action involving Hector's assault and Patroclus' death, and the climactic moment of Achilles' return to combat.
This document provides a summary of the Greek myth of Atalanta, including background details and context. It describes Atalanta as a great huntress from ancient Greece who was abandoned as a baby but raised by bears and later hunters. As an adult, she participated in adventures like the Calydonian boar hunt. The myth tells how she raced suitors for her hand in marriage and was eventually tricked and wed by Hippomenes with the help of golden apples from Aphrodite. The sources and creators of the graphic novel adaptation of the Atalanta myth are also outlined.
الكامل في أسانيد وتصحيح حديث أصحابي كالنجوم بأيهم اقتديتم اهتديتم واختلاف أصح...MaymonSalim
سلسلة الكامل / كتاب رقم ( 206 ) / ( الكامل في أسانيد وتصحيح حديث أصحابي كالنجوم بأيهم اقتديتم اهتديتم واختلاف أصحابي لكم رحمة من خمسة عن النبي وبيان قيامه مقام الحديث المكذوب اختلاف أمتي رحمة ) ، لمؤلفه د/ عامر الحسيني
Paediatric basic life support (PBLS) involves procedures to prevent anoxic brain damage by promoting return of spontaneous circulation and breathing in children. It entails checking response and breathing, then pulse, and performing cycles of chest compressions and rescue breaths in a ratio of 30:2 for one rescuer or 15:2 for multiple rescuers. Key considerations include maintaining an open airway with head tilt and jaw thrust maneuvers rather than finger sweeps, and compressing 1/3 the depth of the chest's anterior-posterior diameter at a fast rate of 100/min until signs of life return, help arrives, or exhaustion occurs.
Umpires have several duties before a match to ensure proper preparation and compliance with laws. On the day before the match, umpires should acknowledge their appointment, review laws, and meet their partner to plan an inspection of the venue. During the inspection, they check facilities, pitch and crease markings, equipment, and observe practice. On match day, umpires arrive at least 45 minutes early to inspect conditions and facilities again. They meet with scorers, captains, and ensure proper markings and compliance with laws before conducting the toss.
This document provides an overview of Greek literature from Homer through the 4th century BC and summaries of important Greek authors, genres, and philosophical works. It also summarizes the major Greek gods and goddesses including Zeus, Hera, Poseidon, Hades, Athena, Apollo, Artemis, Aphrodite, Hermes, Ares, Hephaestus, and Hestia. Greek literature began with Homer's epics and expanded to include lyric poetry, history, and prose. Important authors included Aeschylus, Sophocles, Euripides, Herodotus, and Thucydides. Philosophers such as Socrates, Plato, and Aristotle made significant contributions
The document discusses various procedures and safety considerations for ambulance operations, including:
1) Performing regular equipment checks and vehicle inspections before each call to ensure everything is functioning properly.
2) Driving safely and using lights and sirens appropriately when responding to calls.
3) Parking in safe locations upon arrival at the scene and receiving facility.
This document discusses sports psychology and related topics. It defines psychology as the study of the human mind and behavior. It outlines several branches of psychology including general, individual, applied, child, social, and abnormal psychology. Applied psychology is discussed in relation to preventing mental illness, childhood development, education, career choice, and solving industrial problems. Sports psychology is defined as the study of modern sports and the importance of physical education. Motivation, emotion, and their role in athletic performance are also summarized.
This document provides a lesson plan for a geriatric nursing course. The course spans 12 weeks and covers topics such as the aging process, common diseases in older adults, end-of-life care, and financing healthcare for seniors. The lesson plan outlines objectives, required materials including textbooks and online resources, evaluation methods, and a reference list. The overarching goals are to help students develop knowledge and skills for providing holistic care to geriatric patients.
The document summarizes the story of the Trojan War. It describes how Paris's decision to choose Aphrodite and give Helen to him led Menelaus to wage war on Troy. After 10 years of battle, the Greeks were unable to defeat Troy until Odysseus devised a plan to build a large hollow wooden horse. The Greeks hid inside and gained entry to Troy, allowing them to defeat the Trojans from within the city walls. This ended the Trojan War, though it set up Odysseus's long journey home which is described as the beginning of a new story.
A to Z of trauma care management. This presentation details the various aspect of managing a trauma case in ER and Critical Care unit. Using the A to Z anagram for various aspects makes it easy to remember each and very step that one needs to follow when resuscitating and managing a trauma case. This presentation will be especially useful for trauma nurses and doctors in training.
This document discusses sports injuries, their causes, symptoms, and treatments. It covers acute injuries which occur suddenly from collisions, blows, or falls and chronic injuries from overuse over time from too much stress without recovery. Injuries can be to hard tissues like bones or soft tissues like muscles and ligaments. Treatment depends on the type and severity of injury, ranging from RICE treatment to immobilization and seeking medical help for serious fractures or head injuries. Prevention strategies include proper training, equipment, nutrition, rest, and addressing biomechanical issues.
1. According to Hesiod's Theogony, in the beginning there was Chaos, a formless void, from which emerged Gaia, Tartarus, and Eros. Gaia gave birth to the Titans who were later overthrown by Zeus and the Olympians.
2. Cronus castrated his father Uranus, and from Uranus' blood came the Erinyes, Giants, and Nymphs. Rhea hid Zeus from being eaten by Cronus.
3. Zeus grew up and led the Olympians in the Titanomachy, defeating the Titans and establishing Olympian rule. Later, Deucalion survived Zeus' flood by building an ark and repopulated the
The Trojan War began after Eris, the goddess of discord, was excluded from a wedding and threw a golden apple causing a dispute over which goddess was most beautiful. Paris chose Aphrodite and abducted Helen, sparking Menelaus to call upon Greek leaders to attack Troy. After initial losses, the Greeks learned Troy's location and waged war for many years, losing heroes on both sides, until Odysseus devised the Trojan Horse trick to breach Troy's walls and end the long conflict.
HEMS vs GEMS by ground or by air: which is the best way to take care of traum...Mario Rugna
This document compares HEMS (helicopter emergency medical services) to GEMS (ground emergency medical services) for transporting trauma patients. It finds that:
1) HEMS transports more severely injured patients who require more advanced prehospital treatment, resulting in longer on-scene times.
2) While the sensitivity of prehospital diagnoses is not superior for HEMS crews, HEMS patients have higher access to level 1 trauma centers compared to GEMS.
3) Studies show mixed results on whether HEMS improves survival rates over GEMS, though some evidence suggests HEMS saves at least 1.6 lives per 100 patients transported with serious injuries.
1. The Greek creation myth describes the origins of the universe from primordial deities Ouranos and Gaia. Their offspring included the Hecatonchires, Cyclopes, and Titans like Kronos.
2. Kronos castrated his father Ouranos and became the new ruler, but was destined to be overthrown by his own son. He ate his children to avoid this fate until Zeus was saved.
3. Zeus then overthrew Kronos and became the ruler of Mount Olympus and the gods. He created four races of humans and furnished the earth with life and animals.
Physical therapy can help with recovery from injuries and encourage an active lifestyle by working muscles. The field evolved from events like polio epidemics and wars. Physical therapists must be licensed and typically earn a graduate or doctoral degree. Their duties include assessing patients, developing care plans, and educating on recovery. While the work helps others, it requires extensive schooling and risks burnout from the human services field. Therapists use tools like goniometers, ultrasound, resistance bands and treatment tables.
The document summarizes the plot of the play Antigone by Sophocles. It describes how Antigone defies King Creon's edict by burying her brother Polynices, who was killed in battle against their city of Thebes. Creon sentences Antigone to death, leading to the tragic suicides of Antigone, Creon's son Haemon, and his wife Eurydice due to Creon's stubbornness and refusal to listen to wise counsel.
The document provides an overview of Homer's epic poem The Iliad, including details about its author, type of work, characters, plot, themes, and other literary elements. It was written in ancient Greece around 750 BC and focuses on the Trojan War, particularly the quarrel between Achilles and Agamemnon and its consequences. The summary highlights the major conflict between Achilles and Agamemnon, the rising action involving Hector's assault and Patroclus' death, and the climactic moment of Achilles' return to combat.
This document provides a summary of the Greek myth of Atalanta, including background details and context. It describes Atalanta as a great huntress from ancient Greece who was abandoned as a baby but raised by bears and later hunters. As an adult, she participated in adventures like the Calydonian boar hunt. The myth tells how she raced suitors for her hand in marriage and was eventually tricked and wed by Hippomenes with the help of golden apples from Aphrodite. The sources and creators of the graphic novel adaptation of the Atalanta myth are also outlined.
الكامل في أسانيد وتصحيح حديث أصحابي كالنجوم بأيهم اقتديتم اهتديتم واختلاف أصح...MaymonSalim
سلسلة الكامل / كتاب رقم ( 206 ) / ( الكامل في أسانيد وتصحيح حديث أصحابي كالنجوم بأيهم اقتديتم اهتديتم واختلاف أصحابي لكم رحمة من خمسة عن النبي وبيان قيامه مقام الحديث المكذوب اختلاف أمتي رحمة ) ، لمؤلفه د/ عامر الحسيني
Paediatric basic life support (PBLS) involves procedures to prevent anoxic brain damage by promoting return of spontaneous circulation and breathing in children. It entails checking response and breathing, then pulse, and performing cycles of chest compressions and rescue breaths in a ratio of 30:2 for one rescuer or 15:2 for multiple rescuers. Key considerations include maintaining an open airway with head tilt and jaw thrust maneuvers rather than finger sweeps, and compressing 1/3 the depth of the chest's anterior-posterior diameter at a fast rate of 100/min until signs of life return, help arrives, or exhaustion occurs.
Umpires have several duties before a match to ensure proper preparation and compliance with laws. On the day before the match, umpires should acknowledge their appointment, review laws, and meet their partner to plan an inspection of the venue. During the inspection, they check facilities, pitch and crease markings, equipment, and observe practice. On match day, umpires arrive at least 45 minutes early to inspect conditions and facilities again. They meet with scorers, captains, and ensure proper markings and compliance with laws before conducting the toss.
This document provides an overview of Greek literature from Homer through the 4th century BC and summaries of important Greek authors, genres, and philosophical works. It also summarizes the major Greek gods and goddesses including Zeus, Hera, Poseidon, Hades, Athena, Apollo, Artemis, Aphrodite, Hermes, Ares, Hephaestus, and Hestia. Greek literature began with Homer's epics and expanded to include lyric poetry, history, and prose. Important authors included Aeschylus, Sophocles, Euripides, Herodotus, and Thucydides. Philosophers such as Socrates, Plato, and Aristotle made significant contributions
The document discusses various procedures and safety considerations for ambulance operations, including:
1) Performing regular equipment checks and vehicle inspections before each call to ensure everything is functioning properly.
2) Driving safely and using lights and sirens appropriately when responding to calls.
3) Parking in safe locations upon arrival at the scene and receiving facility.
This document discusses sports psychology and related topics. It defines psychology as the study of the human mind and behavior. It outlines several branches of psychology including general, individual, applied, child, social, and abnormal psychology. Applied psychology is discussed in relation to preventing mental illness, childhood development, education, career choice, and solving industrial problems. Sports psychology is defined as the study of modern sports and the importance of physical education. Motivation, emotion, and their role in athletic performance are also summarized.
This document provides a lesson plan for a geriatric nursing course. The course spans 12 weeks and covers topics such as the aging process, common diseases in older adults, end-of-life care, and financing healthcare for seniors. The lesson plan outlines objectives, required materials including textbooks and online resources, evaluation methods, and a reference list. The overarching goals are to help students develop knowledge and skills for providing holistic care to geriatric patients.
The document summarizes the story of the Trojan War. It describes how Paris's decision to choose Aphrodite and give Helen to him led Menelaus to wage war on Troy. After 10 years of battle, the Greeks were unable to defeat Troy until Odysseus devised a plan to build a large hollow wooden horse. The Greeks hid inside and gained entry to Troy, allowing them to defeat the Trojans from within the city walls. This ended the Trojan War, though it set up Odysseus's long journey home which is described as the beginning of a new story.
A to Z of trauma care management. This presentation details the various aspect of managing a trauma case in ER and Critical Care unit. Using the A to Z anagram for various aspects makes it easy to remember each and very step that one needs to follow when resuscitating and managing a trauma case. This presentation will be especially useful for trauma nurses and doctors in training.
This document discusses sports injuries, their causes, symptoms, and treatments. It covers acute injuries which occur suddenly from collisions, blows, or falls and chronic injuries from overuse over time from too much stress without recovery. Injuries can be to hard tissues like bones or soft tissues like muscles and ligaments. Treatment depends on the type and severity of injury, ranging from RICE treatment to immobilization and seeking medical help for serious fractures or head injuries. Prevention strategies include proper training, equipment, nutrition, rest, and addressing biomechanical issues.
1. According to Hesiod's Theogony, in the beginning there was Chaos, a formless void, from which emerged Gaia, Tartarus, and Eros. Gaia gave birth to the Titans who were later overthrown by Zeus and the Olympians.
2. Cronus castrated his father Uranus, and from Uranus' blood came the Erinyes, Giants, and Nymphs. Rhea hid Zeus from being eaten by Cronus.
3. Zeus grew up and led the Olympians in the Titanomachy, defeating the Titans and establishing Olympian rule. Later, Deucalion survived Zeus' flood by building an ark and repopulated the
The Trojan War began after Eris, the goddess of discord, was excluded from a wedding and threw a golden apple causing a dispute over which goddess was most beautiful. Paris chose Aphrodite and abducted Helen, sparking Menelaus to call upon Greek leaders to attack Troy. After initial losses, the Greeks learned Troy's location and waged war for many years, losing heroes on both sides, until Odysseus devised the Trojan Horse trick to breach Troy's walls and end the long conflict.
HEMS vs GEMS by ground or by air: which is the best way to take care of traum...Mario Rugna
This document compares HEMS (helicopter emergency medical services) to GEMS (ground emergency medical services) for transporting trauma patients. It finds that:
1) HEMS transports more severely injured patients who require more advanced prehospital treatment, resulting in longer on-scene times.
2) While the sensitivity of prehospital diagnoses is not superior for HEMS crews, HEMS patients have higher access to level 1 trauma centers compared to GEMS.
3) Studies show mixed results on whether HEMS improves survival rates over GEMS, though some evidence suggests HEMS saves at least 1.6 lives per 100 patients transported with serious injuries.
1) Medical helicopters have proliferated greatly in the US since the 1990s, doubling over the past decade, though their impact on patient outcomes is unclear.
2) Studies show medical helicopters can transport patients faster than ground ambulances, especially over long distances, but they are much more expensive, with costs 5-10 times higher than ground transport.
3) While helicopters may benefit some critically ill patients, many studies find no difference in outcomes between air and ground transport for most patients, calling into question whether higher costs of helicopters are justified given limited benefits for most cases.
Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for...Jeferson Espindola
Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States
Custo/Efetividade de helicóptero Versus Serviços Terrestre Médicos de Emergência de Trauma no Transporte nos Estados Unidos
The impact of minimally invasive surgery on complex drg assignmentsVojislav Valcic MBA
This study examined whether minimally invasive surgery (MIS) approaches like laparoscopic colectomy, hysterectomy, and thoracic resection result in fewer complex diagnosis-related group (cDRG) assignments compared to open surgeries using data from the Premier hospital database. The researchers found MIS was associated with significantly lower percentages of cDRG assignments for each procedure compared to open surgery. Open surgery increased the odds of a cDRG assignment by 67% compared to MIS. The study estimated that a 10% increase in MIS utilization could lead to annual payer reimbursement savings of approximately $24.4 million.
HRV in trauma patients during prehospital transportRachel Russo, MD
1) The study found that prehospital heart rate variability (HRV), specifically standard deviation of normal-to-normal R-R intervals (SDNN), predicted patients with a base excess ≤-6, those requiring life-saving procedures, and those classified as seriously injured better than routine trauma criteria or vital signs.
2) When used alone as a triage tool, SDNN had a sensitivity of 80%, specificity of 75%, and accuracy of 76% for predicting life-saving interventions, outperforming other prehospital measures.
3) Incorporating SDNN into trauma triage criteria models improved prediction of outcomes compared to models without SDNN, better discriminating patients who were seriously or minimally injured
This document summarizes a study comparing outcomes of general versus spinal anesthesia for total hip arthroplasty. The study found higher odds of adverse events, such as prolonged ventilation and unplanned intubation, with general anesthesia. While many studies have found improved outcomes with spinal anesthesia, it remains underutilized. The interpretation of such database studies is limited as they cannot prove causality. A large prospective randomized trial would be needed to definitively compare the techniques.
KMorton -Impact of an Alternative Admissions Protocol for Multi-system Trauma...Karissa Morton
This study assessed the impact of an alternative admissions protocol for trauma patients with pelvic fractures at a level II trauma center. The previous protocol immediately transferred these patients to a higher level of care due to the lack of an on-site orthopedic surgeon. The new protocol admitted all pelvic fracture patients for stabilization and treatment of injuries before transfer. The study found significantly increased length of stay in the hospital and ICU but no increase in mortality rate and a decreased trend compared to the previous protocol. While hospital stays increased as expected, the protocol proved effective in the absence of on-site orthopedic surgeons and reduced the mortality rate through early treatment of associated injuries.
Whole body ct adult versus ped centers (iep)bahlinnm
1) The study analyzed over 30,000 pediatric trauma patients treated at level I or II adult or pediatric trauma centers to compare the use of whole body CT (WBCT) scans between facilities.
2) It found WBCT scans were used significantly more often on pediatric patients treated at adult trauma centers (31.4%) compared to pediatric centers (17.6%).
3) After adjusting for factors, pediatric patients treated at adult centers were 1.8 times more likely to receive a WBCT, increasing their radiation risk without improving outcomes, as mortality did not differ between the groups. The study concludes guidelines are needed to minimize unnecessary WBCT use across centers.
This summarizes a document about updates in emergency medical services (EMS). It discusses several key points:
1) EMS involves both offline (indirect) protocols and education as well as online (direct) interactions between physicians and providers in the field.
2) Airway and respiratory emergencies are a major focus, and basic techniques like chin lifts can be effective, while blind-insertion devices can also help when used by EMTs.
3) Studies found low success rates for endotracheal intubation in the field, highlighting a need for monitoring practices and potentially using other advanced techniques like cricothyrotomy for difficult airways.
This article discusses the use of prophylactic pressure injury dressings in surgical patients to reduce hospital-acquired skin injuries. It summarizes a study that compared incidences of pressure ulcers in postoperative patients who did not receive protective dressings in the operating room to patients who used an alternating pressure overlay in addition to standard protocols. The study found a reduction in pressure injuries for surgical patients when pressure protective dressings and overlays were used, with no pressure ulcers developing in patients who received the overlay compared to a 6% incidence in historical controls. The article concludes that preventing pressure ulcers in surgical patients through consistent use of protective measures is important to reduce patient suffering and healthcare costs.
This article discusses the use of prophylactic pressure injury dressings in surgical patients to reduce hospital-acquired skin injuries. It summarizes a study that compared incidences of pressure ulcers in postoperative patients who did not receive protective dressings in the operating room to patients who used an alternating pressure overlay in addition to standard protocols. The study found a reduction in pressure injuries for surgical patients when pressure protective dressings and overlays were used, with no pressure ulcers developing in patients who received the overlay compared to a 6% incidence in historical controls. The article concludes that preventing pressure ulcers in surgical patients through consistent use of protective measures is important to reduce patient suffering and healthcare costs.
This document provides information about critical care transport. It discusses desirable characteristics of transport such as being timely, safe, and effective. It compares air and ground transport and factors to consider such as speed, distance, and clinical abilities of the transport crew. The document outlines different models of transport services and discusses guidelines and accreditation. It emphasizes that transport carries risks and the benefits must outweigh the risks, and more research is still needed on outcomes of transporting critically ill patients.
Contents lists available at ScienceDirectApplied Nursing RAlleneMcclendon878
Contents lists available at ScienceDirect
Applied Nursing Research
journal homepage: www.elsevier.com/locate/apnr
Original article
Optimize patient outcomes among females undergoing gynecological
surgery: A randomized controlled trial
Kari Johnson (PhD, RN, ACNS-BC, Hartford Scholar)⁎, Sherry Razo (M.A.-L., BSN, RN, NEA-BC),
Jeannie Smith (BSN, CMSRN), Alex Cain (RN), Kathi Soper (BSN, RN-BC)
Honor Health Thompson Peak Medical Center, 7400 E. Thompson Peak Parkway, Scottsdale, AZ 85255, United States
A R T I C L E I N F O
Keywords:
Gynecological surgery
Enhanced Recovery After Surgery (ERAS)
Hysterectomy
Bundle components
Institute of Healthcare Improvement
Length of stay
30 day readmission
Patient satisfaction
Randomized controlled trial
A B S T R A C T
Background: Optimizing early education in gynecological procedures utilizing an Enhanced Recovery after
Surgery (ERAS) program and a bundle concept may optimize patient outcomes after surgery.
Purpose: Evaluate whether an ERAS bundle compared to standard education can affect length of stay, 30 day
readmission, and patient satisfaction among patients undergoing gynecologic surgery.
Design: Prospective, comparative, randomized design
Setting: 28 bed Medical Surgical Unit
Sample/Intervention: 50 patients undergoing hysterectomy, 25 who received post-operative evidence based
bundle/standard education, and 25 who received standard education packet. Bundle components included 1)
early mobilization, 2) early transition to oral pain medication, 3) early feeding, and 4) chewing gum. A follow-up
phone call was made in two to three days following discharge for both groups utilizing teach-back.
Results: 84% (n = 21) patients in the bundle group were discharged in one day. There were no 30 day read-
missions for both groups. Twenty two (88%) participants met the bundle components 100% of the time. For the
indicator “walking helped with recovery” 100% (n = 25) responded “very good to excellent” for bundle group
and 96% (n = 24) responded “very good to excellent” for standard group. Twenty three (92%) of the bundle
group felt that that overall nursing care received was very good to excellent and 24 (96%) of the general group
felt that overall nursing care received was very good to excellent.
Conclusion: Optimizing peri-operative education using a bundle approach to provide evidence based interven-
tions can minimize risk and enhance early recovery for females undergoing gynecological surgery.
1. Introduction
A hysterectomy is a common gynecological surgical procedure with
minimally invasive methods including vaginal or laparoscopic proce-
dures. Studies have shown that preoperative patient education can
improve patient outcomes after surgery, including reduced length of
hospital stay, decreased post-operative complications, and increased
patient satisfaction with the surgical experience (Modesitt et al., 2016;
Steiner & Strand, 2017; Wijk, Franzen, Ljungqvist, & Nilsson, 2014).
Enhanced recovery p ...
The Evaluation of Time Performance in the Emergency Response Center in Kerman...Emergency Live
The Evaluation of Time Performance in the Emergency Response
Center to Provide Pre-Hospital Emergency Services in Kermanshah
http://www.ccsenet.org/journal/index.php/gjhs/article/view/38288
This document outlines a surgical services disaster response plan for the University of Pittsburgh School of Medicine. It discusses setting up an incident command structure, modifying care to a "greatest good for the greatest number" approach, and key lessons from past disasters like establishing experienced trauma surgeons in triage and carefully managing resources. The plan covers activating response teams, setting up alternative care areas, and modifying documentation to focus on critically injured patients during a mass casualty incident.
The document discusses economics and outcomes in the intensive care unit (ICU). It notes that the majority (80%) of ICU costs are fixed costs like staff salaries, rather than variable costs which fluctuate with patient volume. While reductions in length of stay may decrease some variable costs, they will not significantly impact total costs unless they also reduce fixed expenditures. The impacts of staffing levels, multidisciplinary teams, protocols, and healthcare system organization on ICU outcomes and costs are complex with more research needed.
This study assessed factors that influence physicians' decisions about transporting critically ill patients between hospitals. A survey was sent to intensive care physicians in the Netherlands asking them to rate the transportability of patients described in 16 clinical scenarios varying 8 factors. Conjoint analysis showed that the type of escort personnel and transport facilities had the greatest negative impact on preferences for transportability, while factors reflecting patient severity had less influence. Physicians were more likely to approve transport if specialized intensive care staff and a fully equipped mobile ICU were available. Patient age, arrhythmias, and the reason for transport did not significantly affect decisions.
Duke OHNS Lumbar Drain AN Poster 44x44 vfinalMatthew Crowson
- The study examines whether the pre-operative use of a lumbar drain reduces post-operative cerebrospinal fluid leaks in patients undergoing acoustic neuroma resection.
- 282 patients were included in the study, with 220 receiving a pre-operative lumbar drain and 62 not receiving one. No significant difference was found in CSF leak rates between the two groups.
- While CSF leaks are a common complication, the routine use of pre-operative lumbar drains is not recommended due to the 5.3% complication rate associated with lumbar drain use and no evidence that it decreases CSF leak rates.
The document provides an overview of trauma care systems (TCS). It discusses that TCS aim to provide coordinated care from injury to rehabilitation across prehospital, acute, and rehabilitative care. Key components of effective TCS include leadership, minimum standards, designating trauma centers, evaluation, prevention, and training. Populations at higher risk include children, elderly, and outcomes are measured through survival rates, return to normal activities, and costs across multiple organizations.
The document discusses airway management strategies and clinical options. It emphasizes that airway management should be clinically oriented rather than technically focused. The overall clinical picture and priorities of oxygenation, ventilation, and protection should guide airway management plans. Different techniques like orotracheal intubation, extraglottic devices, bag valve mask ventilation, and surgical airway are options that can be considered as part of a plan that starts with the preferred option but also has backup alternatives if the initial plan fails.
2016 NICE Major Trauma Guidelines. The pre-hospital recomendationsMario Rugna
This document provides guidelines for airway management, chest trauma management, hemorrhage control, circulatory access, fluid resuscitation, heat preservation, pain management, documentation, and training for pre-hospital trauma care. Key recommendations include performing rapid sequence intubation within 45 minutes, using tourniquets and pelvic binders for bleeding, intraosseous access if IV fails, restrictive fluid resuscitation, recording injuries and treatments, and ensuring ongoing training for all trauma clinicians. The guidelines aim to optimize trauma patient care and outcomes in pre-hospital settings.
Forget ACLS Guidelines when dealing with PEA. Part1.Mario Rugna
This document discusses the differences between asystole, pulseless electrical activity (PEA), true PEA/electromechanical dissociation (EMD), and pseudo-PEA in cardiac arrest patients. While an algorithm may indicate the same treatment for asystole and PEA, they are clinically and therapeutically different conditions. The document recommends using central pulse palpation, EKG trace, end-tidal carbon dioxide, and point-of-care ultrasound to differentiate between these non-shockable rhythms and determine the appropriate treatment.
The document compares HEMS (helicopter emergency medical services) to GEMS (ground emergency medical services) and finds that while HEMS patients tend to be more severely injured, requiring more advanced prehospital treatment, the evidence on whether HEMS improves survival rates is inconclusive, though some recent studies show a trend toward increased survival for certain trauma patients transported by HEMS. HEMS may be faster than GEMS for transport times over 10-45 miles depending on simultaneous dispatch. While HEMS provides improved access to trauma centers, the safety risk of helicopter transport is higher than ground ambulances.
The document outlines steps for intubation including preparing, anticipating challenges, ensuring oxygenation and ventilation through various means including initially placing an endotracheal tube, addressing a failed intubation by continuing oxygenation and ventilation, planning for a surgical airway if intubation and ventilation cannot be achieved, and successfully performing a surgical airway with the bottom line being oxygenation and ventilation were maintained.
1. HEMS vsGEMS
by ground or by air: which is the best
way to take care of traumatized
patients
Narrative review by
Mario Rugna
Physician
GEMS and HEMS
Florence, Italy
Visit MEDEST
www.medest118.com
2. References
On line literature search
You can find the original articles mentioned in the
presentation at:
http://1drv.ms/1GtLgLW
3. Cost-Effectivness
Cost-Effectiveness of Helicopter Versus Ground Emergency Medical
Services for Trauma Scene Transport in the United States
M. Kit Delgado, MD, Kristan L. Staudenmayer, MD, N. Ewen Wang
Ann Emerg Med. 2013 October ; 62(4): 351–364.e19.
Conclusions
Compared to ground EMS transport, helicopter scene
transport is cost-effective if it results in a reduction in
the relative risk of death for seriously injured trauma
patients of at least 17% given our model assumptions.
This translates into the need to save at least 1.6 lives
per 100 patients transported with serious injury. Given
current uncertainties, helicopter EMS
Given current evidence, it is not clear that HEMS
achieves this mortality or disability reduction.
Reducing over-triage of minor injury patients to HEMS
would improve its cost-effectiveness.
6. Speed
HEMS to target
Dispatch
Take off
Landing
On the target
Nearby area/rendez-vous with ground EMS
No safe landing space (Winch, hovering )
Dispatch Take-off Landing
7. Speed
Time to reach the target
HEMS vs GEMS
Marco A. Diaz, et al. JTrauma. 2005;58:148–153.
8. Speed
On scene time
Survival benefit of helicopter emergency medical services compared to ground
emergency medical services in traumatized patients
Andruszkow et al. Critical Care 2013, 17:R124
The extent of medical treatment on-scene which involved
intubation, chest and treatment with vasopressors was
more extensive in HEMS (p<0.001) resulting in prolonged
on-scene time (39.5 62 vs. 28.9 minutes, p<0.001).
Impact of prehospital mode of transport after severe injury: A multicenter evaluation
from the Resuscitation Outcomes Consortium
Eileen M. Bulger, Danielle Guffey. JTrauma Acute Care Surg. 2012 March ; 72(3): 567–803
Patients transported by air had higher rates of prehospital
intubation (81% vs. 36%;) received more intravenous fluids
(mean 1.3 L vs. 0.8 L; p< 0.001), and had longer prehospital
times (mean 76.1 minutes vs. 43.5 minutes; p<0.001).
9. Speed
When Is the Helicopter Faster? A Comparison of Helicopter
and Ground AmbulanceTransportTimes
Marco A. Diaz, Gregory W. Hendey, and Herbert G. Bivins, JTrauma. 2005;58:148 –153.
Time from 911 call to hospital
arrival versus distance from
hospital, for ground, non
simultaneously dispatched
(NSD), and simultaneously
dispatched (SD) helicopter
transports. Each bar rep-
resents the mean time from
911 call to hospital arrival, in
minutes, with 95% confidence
intervals.
10. Speed
When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance
TransportTimes
Marco A. Diaz, Gregory W. JTrauma. 2005;58:148 –153.
Results:
Ground trans-ports were significantly faster than non
simultaneously dispatched ( NSD) helicopter transports
at distances under 20 miles. Between 20 and 44 miles,
there was no significant difference, and at distances
greater than 45 miles, NSD helicopter transport was
significantly faster than ground transport
Simultaneously dispatched (SD) helicopter
transports became significantly faster than ground
transport at distances greater than 10miles from the
hospital.
11. Speed
When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance
TransportTimes
Marco A. Diaz, Gregory W. JTrauma. 2005;58:148 –153.
Conclusions:
Ground ambulance transport provided the shortest
911-hospi-tal arrival interval at distances less than 10
miles from the hospital. At distances greater than 10
miles, simultaneously dispatched air transport was
faster.
Non simultaneous dispatched helicopter transport
was faster than ground if greater than 45 miles from
the hospital.
12. Severity
Dennis Den Hartog et al. Injury, Int. J. Care Injured (2015)
Patients in the HEMS group were more severely
injured (ISS 26 versus 22; p < 0.001) and had more
disturbed vital parameters (lower GCS and RTS; p <
0.001).
Andruszkow et al. CriticalCare 2013, 17:R124
Patients treated by HEMS were more seriously
injured compared to GEMS (ISS 26.0 vs. 23.7, P <
0.001) with more severe chest and abdominal injuries.
Bulger et al.JTrauma Acute Care Surg 2012 March
Patients transported by air were more severely
injured (mean Injury Severity Score, 30.3 vs. 22.8;
p<0.001)
13. Severity
HelicopterSceneTransport ofTrauma Patients with NonlifeThreatening Injuries: A Meta-
Analysis
Bryan E. Bledsoe, DO, FACEP, A. KeithWesley, MD, FACEP, Marc Eckstein, MD, FACEP,Thomas M.
Dunn, PhD, Michael F. O’Keefe, MS JTrauma. 2006;60:1257–1266.
Results:
There were 22 studies comprising 37,350 patients that met the inclusion
criteria.
According to the ISS, 60.0% [99% confidence interval (CI): 54.5–64.8] of
patients had minor injuries,
According to theTS, 61.4% (99%CI: 60.8–62.0) of pa-tients had minor injuries.
According toTRISS methodology, 69.3% (99% CI: 58.5– 80.2) of patients had a
greater than 90% chance of survival and thus nonlife threatening injuries.
There were 25.8% (99% CI: 1.0–52.6) of patients discharged within 24 hours
after arrival at the trauma center.
Conclusions:
The majority of trauma patients transported from the scene by helicopter
have nonlife-threatening injuries.
Efforts to more accurately identify those patients who would benefit most
from helicopter transport from the accident scene to the trauma center are
needed to reduce helicopter overutilization.
14. Trauma
Center
Access
Survival benefit of helicopter emergency medical services
compared to ground emergency medical services in traumatized
patients
Andruszkow et al. Critical Care 2013, 17:R124
HEMS patients were more often transported to level
I trauma centers compared to GEMS (HEMS: 90.1%
vs. GEMS: 75.9%). Accordingly, GEMS transported their
patients more frequently to level II (HEMS: 9.9% vs.
GEMS: 24.1%).
15. Crew
Impact of prehospital mode of transport after severe injury:
A multicenter evaluation from the Resuscitation Outcomes
Consortium
Eileen M. Bulger, Danielle Guffey. JTrauma Acute Care Surg.
2012 March ; 72(3): 567–803
Results
Patients transported by air had higher rates of
prehospital intubation (81% vs. 36%; p < 0.001),
received more intravenous fluids (mean 1.3 L vs.
0.8 L; p < 0.001), and had longer prehospital
times (mean 76.1 minutes vs. 43.5 minutes;
p<0.001).
Conclusions
However, air medical transported more severely
injured patients with more advanced life support
procedures and longer prehospital time.
16. Crew
Survival benefit of helicopter emergency medical services
compared to ground emergency medical services in traumatized
patients
Andruszkow et al. Critical Care 2013, 17:R124
Methods:
Traumatized patients (Injury Severity Score; ISS ≥9)
primarily treated by HEMS or ground emergency
medical services (GEMS) between 2007 and 2009 were
analyzed using theTraumaRegister DGU® of the
German Society forTrauma Surgery.
17. Crew
Survival benefit of helicopter emergency medical services compared to ground
emergency medical services in traumatized patients Andruszkow et al. Critical Care
2013, 17:R124
Results:
More preclinical interventions were found in HEMS
transported patients.
18. Crew
Survival benefit of helicopter emergency medical services compared to ground
emergency medical services in traumatized patients Andruszkow et al. Critical Care
2013, 17:R124
Results:
Sensitivity and specificity of preclinical diagnoses were
not superior in HEMS compared to GEMS.
19. Survival
Helicopter emergency medical services for adults with major
trauma (Review 2013)
GalvagnoJr SM,Thomas S, Stephens C, Haut ER, Hirshon JM, Floccare
D, Pronovost P
Author Conclusions
An accurate composite estimate of the benefit of
HEMS could not be determined.
Although five of the nine multivariate regression
studies indicated improved survival associated with
HEMS, the remainder did not.
All were subject to a low quality of evidence as
assessed by the GRADEWorking Group criteria due to
their non-randomized design.
20. Survival
Survival benefit of helicopter emergency medical
services compared to ground emergency medical
services in traumatized patients Andruszkow et al.
Critical Care 2013, 17:R124
Conclusions:
Transportation by HEMS resulted in a significant
survival benefit compared to GEMS patients despite
increased injury severity and incidence of posttrau-
matic complications (MODS, sepsis).
21. Survival
Survival benefit of physician-staffed Helicopter
Emergency Medical Services (HEMS) assistance for
severely injured patients
Dennis Den Hartog,et al. Injury, Int. J. Care Injured (2015)
Conclusions:
The present study indicates an additional 5.33 lives
saved per 100 dispatches of the physician-staffed
HEMS. Given the excellent statistical power of this
study (>90%), physician-staffed HEMS is confirmed to
be an evidence-based valuable addition to the EMS
systems in saving lives of severely injured patients.
22. Bottom line
Speed
MissionTime
In case of simultaneous activation HEMS is competitive
for distance >10 miles
In case of non simultaneous activation HEMS is faster
for distances >45 miles fromTraumaCenter
On scene time
HEMS > GEMS
23. Bottom line
Severity
HEMS patients are generally more severely injured
than GEMS patients
Trauma Center Access
HEMS transported patients have more chances to be
referred to a level ITraumaCenter
24. Bottom line
Crew
More time on scene (beyond the golden hour)
More procedures performed
The accuracy of prehospital documented diagnoses
was not increased in HEMS compared to GEMS rescue
25. Bottom line
Survival
No definitive evidences on HEMS benefits on survival
rate
Recent literature points on a trend toward an increased
chances of survival in some categories of trauma
patients transported by HEMS