Volume 1 Number 1

Child Victims of U.S. Motor Vehicle Crashes: Time from Crash to Hospital Arrival Among Cases Documented in the 2003 Fatality Analysis Reporting System (FARS) Database (Views : 4425 times)

Abstract

There have been recent proposals to enhance organization and funding of emergency care in the U.S. because of perceived deficiencies – especially in services for children.   Motor vehicle crashes are among the leading causes of death and disability for both adults and children in the United States and place a heavy burden on emergency and trauma care.  This study uses the Fatality Accident Reporting System (FARS) to examine the length of time between vehicle crash and hospital arrival for crashes involving seriously injured children transported to hospital in 2003.  Only about 1/3 (1868) of  5436 crashes had data for hospital arrival time.  For those cases that could be evaluated, median transport time was 46 minutes (52 minutes for rural crashes, 35 minutes for those in urban areas).   There was substantial delay in a minority of crashes.  Delays occurred both between crash and emergency services (EMS) notification and between EMS contact and hospital arrival and were more common in rural crashes.  Other research has shown that prolonged transport times are associated with worsened trauma outcomes.  Since states vary in the extent and sophistication of their trauma services we sought, but failed to find,  correlation between number of trauma centers (Level I and II or all-level) per million population and median arrival time calculated for each U.S. state. Integrated trauma care begins at the site of injury and continues through post-hospital care. Time between injury and hospital admission is one important indicator of trauma system performance.

Keywords: Accidents, Traffic; Emergency Medical Services; Children; Transportation of Patients; Trauma Centers; Injuries

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Early postoperative gastric enteral nutrition improves gastric emptying after non-complicated cardiac surgery (Views : 8380 times)

Abstract

Background: Postoperative intragastric enteral feeding in cardiac surgery patients is frequently complicated by delayed gastric emptying.
Objective: To evaluate how early postoperative gastric enteral nutrition affects gastric emptying in coronary artery by-pass graft (CABG) surgery patients.
Methods: In this prospective, randomized study a group of 40 patients treated in the intensive care unit after CABG surgery were studied. Patients were divided in two groups: group E (20 patients: age 59±8 yr.; male 70%) and control group C (20 patients: age 58±10 yr.; male 80%), respectively. The paracetamol absorption test was used to evaluate gastric emptying. In group E gastric enteral nutrition begun 18 hours after surgery and 6 hours later this was stopped and paracetamol solution was administered. The patients in group C received only crystalloid solutions for first 24 hours. Blood samples were obtained at 0 (t0), 15 (t+15), 30 (t+30), 60 (t+60) and 120 (t+120) min after administration of paracetamol.
Results:  The values of plasma paracetamol concentration (PPC) at 15 and 120 min were significantly higher in group E when compared with .group C: (t+15) 3.3±2.5 vs. 1.7±1.9 and (t+120) 5.2±2.8 vs. 3.3±1.6 (p <0.05). The PPC values at 30 and 60 min were higher, but not significantly, in group E vs. group C: (t+30) 3.7±2.0 vs. 2.9±2.7 and (t+60) 5.1±3.2 vs. 3.9±3.5 (p = NS). The area under the PPC curve was 429 ± 309 in the E group vs. 293 ± 204 in the group C (p < 0.05).
Conclusion:  Early postoperative gastric administration of nutritients after CABG surgery stimulates gastric emptying.

Key words: Early postoperative enteral nutrition; gastric emptying

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Initial bradycardia in hypotensive (hemorrhagic) patients in a prehospital setting - does it have a prognostic value? (Views : 21446 times)

Abstract

Introduction. Some studies have shown that the presence of bradycardia in hemorrhage-caused-hypotension is associated with a better prognosis. The aim of this retrospective study was to compare bradycardic and tachycardic responses to hemorrhaging in a pre-hospital setting and to evaluate the outcome.

Patients and methods. All patiens were adults (>18 years) with tachycardia and bradycardia hypotension (hemorrhaging) in a pre-hospital setting. We compared a tachycardic group with a bradycardic group using the following criteria: age, gender, APACHE II on admission, trauma vs. non-trauma patients, outcome (survival) and the use of vasopressors.
Results. Over a two year period, 107 patients were screened. The tachycardic group was younger in age than the bradycardic group. Tachycardia was significantly more common in males. The bradycardic group had better APACHE II on admission and also better outcome (survival). Mortality was lower in bradycardic patients than in tachycardic patients.
Conclusion. Bradycardia is a real phenomenon in hemorrhaging patients in a prehospital setting. It might be associated with both better APACHE II on admission and better outcome.

Keywords: bradycardia, hypotensive (hemorrhagic) patients, prehospital setting, APACHE II, prognosis.

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Intraabdominal hypertension and abdominal compartment syndrome in the intensive care unit (Views : 20078 times)

Abstract

Intraabdominal hypertension can induce a significant dysfunction of cardiovascular, respiratory, renal, and gastrointestinal and central nervous systems. Recently, a prospective multicenter epidemiological study concluded that the intraabdominal hypertension observed in intensive care units was associated with an increased risk of mortality in critically ill patients. In this review, we summarize current literature data concerning definitions and measurement of intraabdominal pressure and discuss the importance of intraabdominal hypertension in critically ill patients. We conclude that intraabdominal pressure should be taken into consideration along with other standard pressure measurements in critically ill patients.

Keywords: intraabdominal pressure, intraabdominal hypertension, abdominal compartment syndrome

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Use of central venous catheters in children (Views : 15110 times)

Abstract

The objective of this study was to evaluate the use of central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Split University Hospital (SUH). We reviewed the records of all children that had CVCs and were hospitalized between January 2002 and March 2006. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site and side of the body of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 352 CVCs were inserted in 300 children. Patient age ranged from 0 to 18 years. The average catheter insertion time was 12.88 days. We noted 66 (18.8%) CVC-related complications. Complications related to CVCs insertion were malposition of catheter (5.4%) and pneumothorax (0.9%). Occlusion of CVCs (4.3%), catheter related-bloodstream infections (CRBI) (4.0%), dislodgment (3.7%) and catheter damage (0.6%) were complications associated with lenght of CVCs use. We conclude that central venous catheterization is a safe and efficient procedure with minimal complications in pediatric patients.

Key words: central venous catheter, indications, complications, children.

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