6 research outputs found
Immobilisering efter trauma: Retrospektiv studie av förekomsten av spinala skador
Bakgrund: Immobilisering aÌr en vedertagen omvaÌrdnadsaÌtgaÌrd inom dagens prehospitala traumavaÌrd, detta trots att det inte finns naÌgra randomiserade kontrollerade studier angaÌende aÌtgaÌrden. MaÌnga studier har dock visat att riskerna med immobilisering aÌr maÌnga varfoÌr det aÌr viktigt att undersoÌka omvaÌrdnadshandlingen naÌrmare. Syfte: Syftet med studien var att undersoÌka foÌrekomsten av radiologiskt faststaÌllda spinala skador hos patienter som immobiliserats prehospitalt efter trauman, samt paÌ vilka indikationer denna immobilisering gjordes. Metod: En kvantitativ retrospektiv studie daÌr 288 journaler granskades i ambulansens journalsystem MobiMed 3.0 och i sjukhusets journalsystem Cosmic. DaÌrefter analyserades resultaten i SPSS deskriptivt och grafiskt, med chi2-test samt med oberoende t-test. Resultat: Resultatet visade att av de 246 patienter som genomgaÌtt en radiologisk undersoÌkning fanns en konstaterad spinal skada hos 48 patienter, vilket motsvarade cirka 17 %. Alla inkluderade patienter hade varit utsatta foÌr trubbigt vaÌld och den vanligaste indikationen foÌr immobilisering var smaÌrta/oÌmhet oÌver kotpelaren. MedelaÌldern hos patienterna med spinala skador var signifikant hoÌgre aÌn medelaÌldern hos de utan spinala skador och en signifikant skillnad fanns mellan patienterna med spinal skada och utan spinal skada och samtidig smaÌrta/oÌmhet oÌver kotpelaren. Slutsats: Ett stoÌrre antal patienter uppvisade skador i denna studie jaÌmfoÌrt med tidigare studier, hos den stora majoriteten fanns dock inga spinala skador. Detta innebaÌr att patienterna utsaÌtts foÌr en potentiellt onoÌdig omvaÌrdnadsaÌtgaÌrd som aÌr svagt vetenskapligt underbyggd och medfoÌr ett flertal risker. Fler studier inom omraÌdet behoÌvs foÌr att kunna minska patienters potentiella lidande i och med att immobiliseras prehospitalt. Background: Spinal immobilization is an established practice in todayâs prehospital trauma care. This even though there is a lack of randomized controlled studies regarding this practice. Many studies points to the risks regarding spinal immobilization why it is of importance to further examine the practice. Aim: The aim of this study was to investigate the incidence of radiologically confirmed spinal injuries in patients immobilized after prehospital trauma and on what indications this immobilization was done Method: A quantitative retrospective study of 288 medical records acquired from the ambulance medical record system Mobimed 3.0 and the hospital's medical record Cosmic were examined. The results were analyzed in SPSS descriptive and graphic, with chi2-test and independent t-test. Result: The results show that of the 246 patients who underwent a radiological examination, 46 had a spinal injury, approximately 17 %. All of the included patients had been exposed to blunt trauma and the most common indication for immobilization was pain/tenderness over the spine. The mean age of the patients with spinal injuries was significantly higher than the mean age of those without spinal injuries. A significant difference was also found between patients with pain/tenderness over the spine and spinal injury and those without spinal injury. Conclusion: A greater number of patients had a spinal injury in this study compared with previous studies, although the majority of the patients had no spinal injury. This means that the majority of the patients were exposed to a potentially unnecessary procedure that lacks scientifically evidence. More studies about immobilization are required to reduce the patients' potential suffering in connection with prehospital immobilization.
Alkoholvanor, trÀningsvanor och upplevd hÀlsa pÄ lÀkarprogrammet och sjuksköterskeprogrammet
Bakgrund: Studenter har en hög konsumtion av alkohol och trĂ€nar i stor utstrĂ€ckning. Alkohol i stora mĂ€ngder har en negativ effekt pĂ„ hĂ€lsan och trĂ€ning har en positiv effekt pĂ„ hĂ€lsan. Studenters upplever generellt sett sin hĂ€lsa som god. Syfte: Att undersöka alkoholvanor, trĂ€ningsvanor och upplevd hĂ€lsa hos studenter pĂ„ lĂ€kar-och sjuksköterskeprogrammet och undersöka eventuella samband och skillnader. Metod: Studien Ă€r en deskriptiv enkĂ€tstudie med 236 deltagare frĂ„n lĂ€kar-och sjuksköterskeprogrammets termin ett och fyra. Resultat: Studenterna drack alkohol och intensivkonsumerade alkohol ofta. De trĂ€nade ocksĂ„ ofta, upplevde liten pĂ„verkan av alkoholvanor pĂ„ trĂ€ningsvanor och upplevd hĂ€lsa. Med ökad Ă„lder minskade alkoholkonsumtionen, lĂ€karstudenter upplevde sin fysiska hĂ€lsa som bĂ€ttre Ă€n vad sjuksköterskestudenterna gjorde och de studenter som trĂ€nade mycket upplevde sin fysiska hĂ€lsa som bĂ€ttre Ă€n de studenter som inte trĂ€nade sĂ„ mycket. Slutsats: Studenters alkohol-och trĂ€ningsvanor och upplevda hĂ€lsa i studien visade stora likheter med tidigare forskning. Mindre andel Ă€n förvĂ€ntat upplevde att alkoholintag hade en negativ pĂ„verkan pĂ„ trĂ€ningen. Mer forskning behövs inom omrĂ„det för att klargöra sĂ€krare samband mellan faktorerna. Ăkad kunskap om studenters alkoholvanor kan ge bĂ€ttre underlag vid folkhĂ€lsofrĂ€mjande arbete
Immobilisering efter trauma: Retrospektiv studie av förekomsten av spinala skador
Bakgrund: Immobilisering aÌr en vedertagen omvaÌrdnadsaÌtgaÌrd inom dagens prehospitala traumavaÌrd, detta trots att det inte finns naÌgra randomiserade kontrollerade studier angaÌende aÌtgaÌrden. MaÌnga studier har dock visat att riskerna med immobilisering aÌr maÌnga varfoÌr det aÌr viktigt att undersoÌka omvaÌrdnadshandlingen naÌrmare. Syfte: Syftet med studien var att undersoÌka foÌrekomsten av radiologiskt faststaÌllda spinala skador hos patienter som immobiliserats prehospitalt efter trauman, samt paÌ vilka indikationer denna immobilisering gjordes. Metod: En kvantitativ retrospektiv studie daÌr 288 journaler granskades i ambulansens journalsystem MobiMed 3.0 och i sjukhusets journalsystem Cosmic. DaÌrefter analyserades resultaten i SPSS deskriptivt och grafiskt, med chi2-test samt med oberoende t-test. Resultat: Resultatet visade att av de 246 patienter som genomgaÌtt en radiologisk undersoÌkning fanns en konstaterad spinal skada hos 48 patienter, vilket motsvarade cirka 17 %. Alla inkluderade patienter hade varit utsatta foÌr trubbigt vaÌld och den vanligaste indikationen foÌr immobilisering var smaÌrta/oÌmhet oÌver kotpelaren. MedelaÌldern hos patienterna med spinala skador var signifikant hoÌgre aÌn medelaÌldern hos de utan spinala skador och en signifikant skillnad fanns mellan patienterna med spinal skada och utan spinal skada och samtidig smaÌrta/oÌmhet oÌver kotpelaren. Slutsats: Ett stoÌrre antal patienter uppvisade skador i denna studie jaÌmfoÌrt med tidigare studier, hos den stora majoriteten fanns dock inga spinala skador. Detta innebaÌr att patienterna utsaÌtts foÌr en potentiellt onoÌdig omvaÌrdnadsaÌtgaÌrd som aÌr svagt vetenskapligt underbyggd och medfoÌr ett flertal risker. Fler studier inom omraÌdet behoÌvs foÌr att kunna minska patienters potentiella lidande i och med att immobiliseras prehospitalt. Background: Spinal immobilization is an established practice in todayâs prehospital trauma care. This even though there is a lack of randomized controlled studies regarding this practice. Many studies points to the risks regarding spinal immobilization why it is of importance to further examine the practice. Aim: The aim of this study was to investigate the incidence of radiologically confirmed spinal injuries in patients immobilized after prehospital trauma and on what indications this immobilization was done Method: A quantitative retrospective study of 288 medical records acquired from the ambulance medical record system Mobimed 3.0 and the hospital's medical record Cosmic were examined. The results were analyzed in SPSS descriptive and graphic, with chi2-test and independent t-test. Result: The results show that of the 246 patients who underwent a radiological examination, 46 had a spinal injury, approximately 17 %. All of the included patients had been exposed to blunt trauma and the most common indication for immobilization was pain/tenderness over the spine. The mean age of the patients with spinal injuries was significantly higher than the mean age of those without spinal injuries. A significant difference was also found between patients with pain/tenderness over the spine and spinal injury and those without spinal injury. Conclusion: A greater number of patients had a spinal injury in this study compared with previous studies, although the majority of the patients had no spinal injury. This means that the majority of the patients were exposed to a potentially unnecessary procedure that lacks scientifically evidence. More studies about immobilization are required to reduce the patients' potential suffering in connection with prehospital immobilization.
Physiological respiratory parameters in pre-hospital patients with suspected COVID-19 : A prospective cohort study
Background The COVID-19 pandemic has presented emergency medical services (EMS) worldwide with the difficult task of identifying patients with COVID-19 and predicting the severity of their illness. The aim of this study was to investigate whether physiological respiratory parameters in pre-hospital patients with COVID-19 differed from those without COVID-19 and if they could be used to aid EMS personnel in the prediction of illness severity. Methods Patients with suspected COVID-19 were included by EMS personnel in Uppsala, Sweden. A portable respiratory monitor based on pneumotachography was used to sample the included patient's physiological respiratory parameters. A questionnaire with information about present symptoms and background data was completed. COVID-19 diagnoses and hospital admissions were gathered from the electronic medical record system. The physiological respiratory parameters of patients with and without COVID-19 were then analyzed using descriptive statistical analysis and logistic regression. Results Between May 2020 and January 2021, 95 patients were included, and their physiological respiratory parameters analyzed. Of these patients, 53 had COVID-19. Using adjusted logistic regression, the odds of having COVID-19 increased with respiratory rate (95% CI 1.000-1.118), tidal volume (95% CI 0.996-0.999) and negative inspiratory pressure (95% CI 1.017-1.152). Patients admitted to hospital had higher respiratory rates (p<0.001) and lower tidal volume (p = 0.010) compared to the patients who were not admitted. Using adjusted logistic regression, the odds of hospital admission increased with respiratory rate (95% CI 1.081-1.324), rapid shallow breathing index (95% CI 1.006-1.040) and dead space percentage of tidal volume (95% CI 1.027-1.159). Conclusion Patients taking smaller, faster breaths with less pressure had higher odds of having COVID-19 in this study. Smaller, faster breaths and higher dead space percentage also increased the odds of hospital admission. Physiological respiratory parameters could be a useful tool in detecting COVID-19 and predicting hospital admissions, although more research is needed
Suction cup on a piston-based chest compression device improves coronary perfusion pressure and cerebral oxygenation during experimental cardiopulmonary resuscitation
Introduction: The presented study aimed to investigate whether a mechanical chest compression piston device with a suction cup assisting chest recoil could impact the hemodynamic status when compared to a bare piston during cardiopulmonary resuscitation. Methods: 16 piglets were anesthetized and randomized into 2 groups. After 3 minutes of induced ventricular fibrillation, a LUCAS 3 device was used to perform chest compressions, in one group a suction cup was mounted on the device's piston, while in the other group, compressions were per -formed by the bare piston. The device was used in 30:2 mode and the animals were manually ventilated. Endpoints of the study were: end tidal carbon dioxide, coronary and cerebral perfusion pressures, and brain oxygenation (measured using near infrared spectroscopy). At the end of the protocol, the animals that got a return to spontaneous circulation were observed for 60 minutes, then euthanized. Results: No difference was found in end tidal carbon dioxide or tidal volumes. Coronary perfusion pressure and cerebral oxygenation were higher in the Suction cup group over the entire experiment time, while cerebral perfusion pressure was higher only in the last 5 minutes of CPR. A passive tidal volume (air going in and out the airways during compressions) was detected and found correlated to end tidal carbon dioxide. Conclusions: The use of a suction cup on a piston-based chest compression device did not increase end tidal carbon dioxide, but it was associated to a higher coronary perfusion pressure
Continuous chest compressions are associated with higher peak inspiratory pressures when compared to 30:2 in an experimental cardiac arrest model
BACKGROUND: Ventilation during cardiopulmonary resuscitation (CPR) has long been a part of the standard treatment during cardiac arrests. Ventilation is usually given either during continuous chest compressions (CCC) or during a short pause after every 30 chest compressions (30:2). There is limited knowledge of how ventilation is delivered if it effects the hemodynamics and if it plays a role in the occurrence of lung injuries. The aim of this study was to compare ventilation parameters, hemodynamics, blood gases and lung injuries during experimental CPR given with CCC and 30:2 in a porcine model. METHODS: Sixteen pigs weighing approximately 33Â kg were randomized to either receive CPR with CCC or 30:2. Ventricular fibrillation was induced by passing an electrical current through the heart. CPR was started after 3Â min and given for 20Â min. Chest compressions were provided mechanically with a chest compression device and ventilations were delivered manually with a self-inflating bag and 12Â l/min of oxygen. During the experiment, ventilation parameters and hemodynamics were sampled continuously, and arterial blood gases were taken every five minutes. After euthanasia and cessation of CPR, the lungs and heart were removed in block and visually examined followed by sampling of lung tissue which were examined using microscopy. RESULTS: In the CCC group and the 30:2 group, peak inspiratory pressure (PIP) was 58.6 and 35.1 cmH2O (pâ<â0.001), minute volume (MV) 2189.6 and 1267.1Â ml (pâ<â0.001), peak expired carbon dioxide (PECO2) 28.6 and 39.4Â mmHg (pâ=â0.020), partial pressure of carbon dioxide (PaCO2) 50.2 and 61.1Â mmHg (pâ=â0.013) and pH 7.3 and 7.2 (pâ=â0.029), respectively. Central venous pressure (CVP) decreased more over time in the 30:2 group (pâ=â0.023). All lungs were injured, but there were no differences between the groups. CONCLUSIONS: Ventilation during CCC resulted in a higher PIP, MV and pH and lower PECO2 and PaCO2, showing that ventilation mode during CPR can affect ventilation parameters and blood gases