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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Impact of prehospital rapid sequence intubation and mechanical ventilation on prehospital vital signs and outcome in trauma patients


Introduction. Medications during rapid sequence intubation (RSI) have known detrimental side effects. Prehospital mechanical ventilation after successful endotracheal intubation also increases mortality due to hyperventilation and positive pressure ventilation. The aim of this retrospective analysis was to determine the impact of RSI on prehospital hemodynamic parameters and prehospital ventilation status on mortality rate and functional outcome in trauma patients.

Methods. Charts of 73 trauma patients, who underwent prehospital RSI over a 12-year period, were retrospectively reviewed. Prehospital vital signs, before and after RSI, were compared. Patients were divided, according to ventilation status, into three groups based on initial PaCO2: hypocarbic/hyperventilated (PaCO2<35mmHg), normocarbic/normoventilated (PaCO2 35-45 mmHg) and hypercarbic/hypoventilated (PaCO2>45mmHg).

Results. Seventy-three patients were enrolled in the retrospective analysis. There was a significant difference in respiratory rate (p=0.046), arterial oxygen saturation (p<0.001), mean arterial pressure (p<0.001) and Glasgow Coma Scale (GCS) (p<0.001) before and after RSI. GCS at discharge (p=0.003) and arterial oxygen saturation (p=0.05) were significantly higher in the normoventilated group. There was no significant difference in survival to hospital discharge among compared groups.

Conclusion. Our retrospective analysis suggests that prehospital RSI has no detrimental hemodynamic side effects and that normoventilation leads to a favorable neurological outcome.

Key words: intubation, prehospital, mechanical ventilation, trauma, hemodynamics

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Medical students perform basic life support skills in a simulated scenario better using a 4-stage teaching approach compared to conventional training


Introduction. Cardiopulmonary resuscitation is influenced by the quality of basic life support (BLS). The primary objective of our study was to compare efficiency in the acquisition of BLS skills using conventional training and the 4-stage approach as a teaching method for BLS training.

Methods. In a prospective, randomised, 2-parallel group study, 266 first year medical students were randomised to either conventional training or the 4-stage approach using 2000 and 2005 ERC (European Resuscitation Council) guidelines. The students were tested immediately after receiving training. Three ERC-certified instructors assessed BLS skills using video recordings.

Results. The students who were taught according to the 4-stage approach using 2000 guidelines preformed significantly better in the following steps: calls for help (p<0.01), opens the airway (p<0.01), places hands for chest compression correctly (p<0.01) and performs chest compressions correctly (p<0.01), while using 2005 guidelines, only chest compression hand position improved significantly in the 4-stage teaching group (p<0.01).

Conclusions. The 4-stage approach improved the efficiency of several steps of the BLS algorithm and the ability to follow the algorithm in the correct sequence using 2000 ERC guidelines, while in students using the 2005 ERC guidelines only chest compression hand position improved significantly. Students who were taught according to 2000 ERC guidelines had significantly better hand position than students who were taught according to 2005 guidelines, independent of teaching method used.

Key words: basic life support, education, medical students, teaching method

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Outbreak of Pseudomonas aeruginosa in a Neonatal Intensive Care Unit: Are Point-of-Use Filters Useful?


Pseudomonas aeruginosa, in intensive care units (ICUs), causes infections with high morbidity and mortality rates. Tap water outlets are often contaminated with P.aeruginosa and may represent a source of endemic infections in ICUs.

The aim of this study was to explore the role of point-of-use (POU) filters in neonatal intensive care unit (NICU) in reducing P.aeruginosa colonizations/infections.

Routine surveillance cultures, environmental cultures and samples from the hands of healthcare personnel, were taken and cultivated. P.aeruginosa isolates were identified according to standard procedures. For epidemiological purposes, antimicrobial susceptibility testing and pulse-field gel electrophoresis were performed.

Data regarding use of antibiotics, disinfectants, antiseptics, gloves and gowns from 2006 to 2012 were investigated.

In March 2008, in the NICU of the Clinical Hospital Centre Zagreb (CHC Zagreb), we observed an increase in the total number of pseudomonas infections compared to the previous months. This higher number remained the same until October, despite rigorous infection control measures.

Pseudomonas isolates were found in tap water, but not on the hands of healthcare workers. In that moment POU filters were introduced. The number of P.aeruginosa isolates in surveillance cultures dropped significantly.

The number of positive cultures of P.aeruginosa in two consecutive periods (before and after installation of POU filters) showed a statistically significant difference.

After the implementation of all infection control measures, we managed to stop the spread of pseudomonas colonization/infection. POU filters contributed only as one of these measures, resulting in a reduction of chronically endemic P.aeruginosa infection/colonisation in the NICU.

Key words: P.aeruginosa, neonatal intensive care unit, point of use filters, infection control

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2nd South Eastern European Joint Meeting of Thoracic Anesthesiologists and Surgeons (Book of abstracts)

Slovenia, Ljubljana, 12-13 April, 2017


University Medical Centre Ljubljana

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Early VATS for Blunt Chest Trauma


The role of Video-Assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We reported our isolated blunt chest trauma cases managed by VATS and reviewed the role of VATS in the management of this kind of thoracic trauma.

Keywords: blunt thoracic trauma, haemothorax, Video-Assisted Thoracoscopic Surgery.

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