Oral transmucosal fentanyl citrate analgesia in prehospital trauma care: an observational cohort study.

BACKGROUND Pain is one of the major prehospital symptoms in trauma patients and requires prompt management. Recent studies have reported insufficient analgesia after prehospital treatment in up to 43% of trauma patients, leaving significant room for improvement. Good evidence exists for prehospital use of oral transmucosal fentanyl citrate (OTFC) in the military setting. We hypothesized that the use of OTFC for trauma patients in remote and challenging environment is feasible, efficient, safe, and might be an alternative to nasal and intravenous applications. METHODS This observational cohort study examined 177 patients who were treated with oral transmucosal fentanyl citrate by EMS providers in three ski and bike resorts in Switzerland. All EMS providers had previously been trained in administration of the drug and handling of potential adverse events. RESULTS OTFC caused a statistically significant and clinically relevant decrease in the level of pain by a median of 3 (IQR 2 to 4) in NRS units (P < 0.0001). Multiple linear regression analysis showed a significant absolute reduction in pain, with no differences in all age groups and between genders. No major adverse events were observed. CONCLUSIONS Prehospital administration of OTFC is safe, easy, and efficient for extrication and transport across all age groups, gender, and types of injuries in alpine environments. Side effects were few and mild. This could provide a valuable alternative in trauma patients with severe pain, without the delay of inserting an intravenous line, especially in remote areas, where fast action and easy administration are important

analysis of prehospital anesthesia at HEMS CHRISTOPH 18

Narkose und Intubation als definitive Atemwegssicherung gehören zu den Standards der präklinischen Notfalmedizin. Allerdings wird dieses Verfahren gerade in der Präklinik durch verschiedene Faktoren erschwert. Ziel der vorliegenden Arbeit war es anhand des Einsatzspektrums des Rettungshubschraubers CHRISTOPH 18 das Vorgehen bei solchen präklinischen Narkosen zu untersuchen und die auftretenden Schwierigkeiten zu erfassen. Die dargestellten Ergebnisse zeigen, dass im Einsatzspektrum des RTH CHRISTOPH 18 die Schwierigkeiten der präklinischen Narkoseeinleitung im Vergleich zu anderen Publikationen gering ausfallen. Hierfür kommen verschiedene Ursachen in Betracht: Zum einen entstammen viele Publikationen zu diesem Thema dem angloamerikanischen Sprachraum und basieren dementsprechend auf Daten aus einen Rettungssystem ohne Notärzte, zum anderen sind auf dem Rettungshubschrauber CHRISTOH 18 ausschließlich Anästhesisten mit entsprechender Erfahrung im Atemwegsmanagement als Notärzte eingesetzt.Induction of general anesthesia and definitive airway control by endotracheal intubation (ETI) is standard of care in pre-hospital emergency medicine. However, there are specific factors that may influence and complicate these procedure. Aim of this study was to show the approach and the difficulties in prehospiatl airway management at the HEMS CHRISTOPH 18. The findings proof that the difficulties are low compared to other publications. Different reasons come into consideration: On the one hand side most of the studies took place in prehospital emergency systems based on paramedics without emergency physicians and on the other hand side the physicians at HEMS CHRISTOPH 18 are only anestetists with long exsperience in airway management

Videolaryngoskopie im Notfall sinnvoll einsetzen

Die Bedeutung eines erfolgreichen ersten Intubationsversuchs in der Atemwegssicherung ist in mehreren Studien belegt. Zum Gelingen können neben einer guten Ausbildung und regelmäßigem Training vor allem ein standardisiertes Vorgehen im Team mit ausgiebiger Präoxygenierung und optimaler Lagerung des Patienten sowie eine ausreichend tiefe Narkose unter Einsatz von Muskelrelaxanzien und schließlich der Einsatz eines Videolaryngoskops bereits mit dem ersten Intubationsversuch beitragen. Dieser Artikel beschreibt die Möglichkeiten der Videolaryngoskopie in der prähospitalen Notfallmedizin

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study.

Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™).Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion.The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW ± SD) did not show significant differences with 17 ± 7 (EZ-IO tibia) vs. 29 ± 42 (EZ-IO humerus) vs. 33 ± 21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27 ± 5 to 69 ± 54 ml/min (EZ-IO tibia), 16 ± 3 to 60 ± 44 ml/min (EZ-IO humerus) and 53 ± 2 to 112 ± 47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107-0.366; p ≤ 0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63-0.80; p ≤ 0.007). Post-hoc statistical power was 0.62 with the given sample size.The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings

Participant grading, insertion time and number of attempts using the EZ-IO tibia, EZ-IO humerus and FASTR devices.

<p>Participant grading, insertion time and number of attempts using the EZ-IO tibia, EZ-IO humerus and FASTR devices.</p

Pressure-dependent flow rates per minute in unfixed donors using the EZ-IO tibia, EZ-IO humerus and FASTR device.

<p>Pressure-dependent flow rates per minute in unfixed donors using the EZ-IO tibia, EZ-IO humerus and FASTR device.</p