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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Prognostic value of lactate in prehospital care as a predictor of mortality and high-risk patients with trauma

Abstract

Objectives. Major injury is a time-dependent illness in which the quantification of the life prognosis is fundamental for professionals. The objective of this study is to evaluate the capacity of prehospital lactic acid to predict mortality (2, 7 and 30 days) and the admission to the Intensive Care Unit (ICU) from the index event.

Methods. This is a longitudinal, prospective observational study, which included patients who were treated by an Advanced Life Support Unit and transferred to the Emergency Department between April 1 and September 30, 2018. We calculated sensitivity, specificity, and likelihood ratios. The main outcome variable was mortality from any cause (2, 7 and 30 days) and admission to ICU.

Results. 109 patients were included in our study. Eleven patients (10%) experienced early mortality before the first 48 hours after the index event, with an ICU admission rate of 28%. The sensitivity and specificity of the test to determine mortality in less than two days was 63.6% (95% CI, 35.4-84.8%) and 87.8% (95% CI, 79.8-92.9%).

Conclusions. Prehospital lactic acid has an excellent capacity to predict the mortality and the admission of patients with major injury to the ICU, and it is a cheap, easy-to-obtain and reliable diagnostic tool that can help in clinical decision-making.

Key words: Critical care, emergency department, outcome, survival, intensive care

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Geriatric patients in the ICU

Abstract

The proportion of patients older than 80 years admitted to the ICU is constantly increasing. Despite well-known admission criteria, older patients are frequently not referred and are admitted to the ICU. The emergency ward and ICU management of acute medical conditions should not depend on age only, but should be tailored to the individual patient in line with standards of care. After the successful treatment of acute illness, elderly people should receive complex and prolonged physical, social and psychological rehabilitation. Nevertheless, we must be able to recognize the point of futile treatment and provide proper palliative care. Less traumatised procedures that are better tolerated are preferred in the management of specific medical conditions in geriatric patients. General preventive programs promoting healthy lifestyles have been developed, but these must be implemented by a majority of older people. Medical science should promote adequate education of all professionals who are involved in the treatment of geriatric patients; societies should provide equal access to health-care in developed countries and countries in transition.

Key words: intensive care unit, outcome, survival, elderly, treatment intensity

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Genetic determinants of survival

Abstract

The human genome comprises some 20,000 genes, or 3 billion base pairs. Variation in this genetic sequence is common and some of these variants affect gene function or the protein transcribed from it. Human characteristics are determined by the interaction of the genome with environmental challenges, and differences between us thus result from variation in those challenges and in the genome itself. This is true of human susceptibility to disease, and survival from it. Genetic variation influences human behaviours which may predispose to health or disease; the risk of contracting an infectious disease, or of suffering diseases such as cancer or myocardial infarction; the development of complications; the response to any treatment administered; and thus the outcome of the disease state. Genetic studies can help shed light on the mechanisms which underpin disease processes, whilst perhaps suggesting ways in which treatment might be ‘personalised’, and novel therapeutic targets for drug development.

More sophisticated approaches to such endeavours are required, given the failure to identify the bulk of gene variants of influence using conventional strategies.

Key words: gene, polymorphism, survival, genome

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Genetic determinants of survival

Abstract

The human genome comprises some 20,000 genes, or 3 billion base pairs. Variation in this genetic sequence is common- and some of these variants affect gene function or the protein transcribed from it. Human characteristics are determined by the interaction of the genome with environmental challenges- and differences between us thus result from variation in those challenges and in the genome itself. This is true of human susceptibility to disease, and survival from it. Genetic variation influences human behaviours which may predispose to health or disease; the risk of contracting an infectious disease, or of suffering diseases such as cancer or myocardial infarction; the development of complications; the response to any treatment administered; and thus the outcome of the disease state. Genetic studies can help shed light on the mechanisms which underpin disease processes, whilst perhaps suggesting ways in which treatment might be ‘personalised’, and novel therapeutic targets for drug development.

More sophisticated approaches to such endeavours are required, given the failure to identify the bulk of gene variants of influence using conventional strategies.

Key words: Gene, polymorphism, survival, genome

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Automated external defibrillator skills among lay people in the region of Koroska: a pilot study

Abstract

Background. In the region of Koroška, there are more and more public spaces equipped with automated external defibrillators which can be used by a witnessed bystander. The aim of this study was to gain insight into the skills required for using automated external defibrillators.

Methods. This was a cross-sectional survey conducted in two family medicine practices. We included volunteers who visited their family doctor during a period of four days. Skills were assessed in a virtual setting using a plastic manikin.

Results. There were 107 participants in the sample, 60.0% were women. Average age of the sample was 47.6±16.8 years. In the practical part (skills testing), the participants earned 2.7 points from a total of 5 points. Younger participants and those who attended a course in basic life support, in the past 10 years, had a significantly higher score.

Conclusion. Lay people need more education regarding skills for using automated external defibrillators.

Key words: automated external defibrillator, basic life support, lay people, survival, cardiac arrest

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