Whole-body CT in polytrauma patients: effect of arm positioning on thoracic and abdominal image quality

The purpose of this study is to assess the influence of different arm positioning techniques on thoracic and abdominal image quality and radiation dose of whole-body trauma CT (wbCT). One hundred and fifty polytrauma patients (104 male, mean age 47 ± 19) underwent wbCT with arms elevated above the head (group A, n = 50), alongside the abdomen (group B, n = 50), and on a pillow ventrally to the chest with both arms flexed (group C, n = 50). Two blinded, independent observers measured image noise and rated image quality (scores 1-3) of the liver, aorta, spleen, spine, and lower lungs. Radiation dose parameters were noted, and the abdomens' anterior-posterior diameter and scan lengths were measured. Interreader agreements for image noise (r = 0.86; p < 0.001) and subjective image quality (k = 0.71-0.84) were good. Noise was lower (p < 0.05), image quality of the liver, aorta, spleen, and spine was higher, and radiation dose lower in group A than in groups B and C (p < 0.001, each). Image quality of the spleen, liver, and aorta were higher in group C than in group B (p < 0.05, each). No significant differences in scan length (p = 0.61) were found among groups. Abdominal anterior-posterior diameter correlated significantly with noise (r = 0.82; p < 0.01) and dose (r = 0.47; p < 0.001). Estimated effective radiation doses were significantly (p < 0.001) higher in groups B (21.2mSv) and C (21.9mSv) as compared to A (16.1mSv). In wbCT for polytrauma patients, positioning of the arms above the head results in better image quality and lower radiation dose. Placing the flexed arms on a large pillow ventrally to the chest significantly improves image quality as compared to positioning alongside the abdome

The FIT-System: A New Hand-Held Computer Tool for Ergonomic Assessment

Objective is the recording of tasks, links and team work of anesthesia work procedures a multidiscipline operating room (OR) facility. Method is a common mobile hand-held computer device with a flexible interface technique, called the FIT-System. Main idea is, that the observer can design his own computer interface on a paper overlay according to his representation of the situation. Anesthesia procedures during surgery and induction were inspected with the FIT-System in several projects. Some of them are presented in this paper as examples to demonstrate the use of the FIT-System which shows it’s usability and the advantage in time, costs, flexibility and ethics, that event recording can be done without video filming.ISSN:1741-0444ISSN:0140-011

Beteiligungsorientierte Arbeitsplatzanalyse: Schwachstellen im Arbeitssystem der Anästhesie in einem multidisziplinären OP-Trakt

Fragestellung. In einem multidisziplinären Operationstrakt eines Universitätsspitals sollten im Arbeitssystem der Anästhesie Schwachstellen in der technischen Arbeitsgestaltung erkannt und verstanden werden. Methoden. Von einem Ergonomen wurden die Arbeitsplätze und -abläufe mit Beobachtungen, computergestützten Tätigkeitsaufzeichnungen sowie Video- und Fotoaufnahmen analysiert. Ein leitfadenorientiertes Interview wurde durchgeführt. Darstellungen der Arbeitsabläufe wurden hierzu als Hilfen zur Explikation des Erfahrungswissens eingesetzt. Die Hintergründe des Problemgefüges und mögliche Verbesserungen wurden für die Beteiligten visualisiert. Ergebnisse. Als wesentliche Mängel wurden erkannt: Die Geräteaufstellung außerhalb ergonomischer Blick- und Greifräume, schwierig zu handhabende Kabel- und Schlauchverbindungen und die uneinheitliche Arbeitsplatzgestaltung. Als Ursachen hierfür konnten Planungsfehler in der Einrichtung der Abteilung und ergonomisch schlecht gestaltete Arbeitsmittel identifiziert werden. Als erste Verbesserungsmaßnahmen wurden ein neues Konzept der Geräteanordnung und eine neue Ordnungshilfe für die Handhabung der Verbindungsleitungen entwickelt

Blood component ratios in massively transfused, blunt trauma patients--a time-dependent covariate analysis

This study evaluated critical thresholds for fresh frozen plasma (FFP) and platelet (PLT) to packed red blood cell (PRBC) ratios and determined the impact of high FFP:PRBC and PLT:PRBC ratios on outcomes in patients requiring massive transfusion (MT)

The value of pre-hospital trauma life support courses for medical personnel-a questionnaire study

BACKGROUND The aim of the study was to determine the impact that PHTLS$^{®}$ course participation had on self-confidence of emergency personnel, regarding the pre-hospital treatment of patients who had suffered severe trauma. Furthermore, the goal was to determine the impact of specific medical profession, work experience and prior course participation had on the benefits of PHTLS$^{®}$ training. METHODS A structured questionnaire study was performed. Healthcare providers from local emergency services involved in pre-hospital care in the metropolitan area of Zurich (Switzerland, Europe) who completed a PHTLS$^{®}$ course were included. Altered self-confidence, communication, and routines in the treatment of severe trauma patients were examined. The impact of prior course participation, work experience and profession on course benefits were evaluated. RESULTS The response rate was 76%. A total of 6 transport paramedics (TPs), 66 emergency paramedics (EPs) and 15 emergency doctors (EDs) were included. Emergency paramedics had significantly more work experience compared with EDs (respectively 7.1 ± 5.7 yrs. vs. 4.5 ± 2.1 yrs., p = 0.004). 86% of the participants reported increased self-confidence in the pre-hospital management of severe trauma upon PHTLS$^{®}$ training completion. Moreover, according to 84% of respondents, extramural treatment of trauma changed upon course completion. PHTLS$^{®}$ course participants had improved communication in 93% of cases. This was significantly more frequent in EPs than TPs (p = 0.03). Multivariable analysis revealed emergency paramedics benefit the most from PHTLS$^{®}$ course participation. CONCLUSION The current study shows that PHTLS$^{®}$ training is associated with improved self-confidence and enhanced communication, with regards to treatment of severe trauma patients in a pre-hospital setting, among medical emergency personnel. Additionally, emergency paramedics who took the PHTLS$^{®}$ course improved in overall self-confidence. These findings imply that all medical personal involved in the pre-hospital care of trauma patients, in a metropolitan area in Europe, do benefit from PHTLS® training. This was independent of the profession, previous working experience or prior alternative course participation

Impact of city police layperson education and equipment with automatic external defibrillators on patient outcome after out of hospital cardiac arrest

INTRODUCTION: Out of hospital cardiac arrest (OHCA) occurs frequently and the outcome is often dismal. Early defibrillation saves lives and brain function in OHCA. The Zurich city police (STAPO) forces were instructed and equipped to provide basic life support (BLS) and to use an AED in 2009. METHODS: Retrospective observational study comparing period 1 (P1) 2004-2009 before equipping and training of the STAPO and period 2 (P2) 2010-2015 after the implementation. Patients suffering from OHCA of cardiac or presumed cardiac origin in the city of Zurich undergoing CPR by EMS in P1 (n=709) and P2 (n=684) were included. Intervention periods and outcome were compared between the periods. Outcome variables were adjusted for patient age and gender, witnessed status, and defibrillation by the EMS, STAPO, layperson or no defibrillation. RESULTS: In P2, CPR was started by the STAPO in a median of 8 (IQR 6-9) minutes after the arrest and thus significantly earlier (median 3min) than by the EMS (p<0.001). STAPO performed the first defibrillation in a median of 9 (IQR 8-10) minutes and thus significantly earlier (median 6min) than the EMS (p<0.001). Outcome improved significantly in P2: proportion of patients with return of spontaneous circulation (ROSC, P2 35.8%, P1 24.0%, OR 1.8, 95% CI 1.4-2.2, p<0.001), hospital admission (P2 32.2%, P1 21.4%, OR 1.7, 95% CI 1.4-2.2, p<0.001) and survival to hospital discharge (P2 13.6%, P1 6.9%, OR 2.1 95% CI 1.5-3.0, p<0.001). If the patient was firstly defibrillated by the STAPO, ROSC (STAPO 74.4%, adj. OR 2.6, 95% CI 1.3-5.4, p=0.010) and hospital admission (STAPO 72.1%, adj. OR 2.8, 95% CI 1.4-5.6, p=0.005) was higher compared to patients firstly defibrillated by the EMS. Survival to hospital discharge (STAPO 30.2%, adj. OR 1.4, 95% CI 0.7-2.9, p=0.38) was unchanged. CONCLUSION: Dispatching BLS trained and AED equipped police forces results in earlier and more successful resuscitation of OHCA victims, leading to higher proportions of patients with ROSC, hospital admission and survival to hospital discharge

Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS) algorithms

PURPOSE Pre-hospital trauma life support (PHTLS) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment. METHODS We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS qualified team. We compared outcome between groups. RESULTS During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups. CONCLUSION This is the first study to show that the implementation of PHTLS algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS in metropolitan areas in the first world