Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

COVID-19 UPDATES

COVID-19 has greatly impacted our lives and the healthcare system in the most recent times.
Air ambulance services are facing several challenges when dealing with highly infectious patients.
We collect here all most recent research updates on COVID-19 emergency procedures published in the journal to make them easily discoverable to the research community

RECURRENT VENTRICULAR FIBRILLATION CARDIAC ARRESTS IN A 3-MONTH OLD BOY

Sudden cardiac arrest in infancy is an extremely rare evenience. The overall low numbers of out-of-hospital cardiac arrests, together with the obvious ethical restrictions on clinical trials in children, has resulted in national guidelines mainly relying on  case reports, retrospective registry studies, animal modelling and studies exploring resuscitation in the adult population. This results in a lack of high-quality evidence on which to make recommendations on many fundamental aspects of a resuscitation. 
Here P. Kingsley et al. report a very challenging case of resuscitation for recurrent ventricular fibrillation cardiac arrests in an infant.

HOW AND WHY HAS EMERGENCY DEPARTMENT AND PRE-HOSPITAL EMERGENCY ANAESTHESIA CHANGED?

Emergency airway management both in the emergency dept. and in the pre-hospital phase of care is not only a key intervention but also a cause of much controversy and uncertainty. Rapid sequence induction (RSI) is the method that we use to try to achieve definitive airway control effectively and rapidly. The original descriptions of RSI delivered great consistency for many years but almost every aspect has been challenged. Avery & coll., in this review, reminded us of what was originally described and looked at how and why this consensus has been lost. There are very good reasons why variations occur and this article gives an insight into how emergency anaesthesia is conducted now and what factors are likely to influence practice in the immediate future. 
SJTREM Editorial Team

GCS ≤ 8: IS INTUBATION THE FIRST CHOICE?

Despite the relationship between the level of consciousness and intubation need is not yet sufficiently subject to evidence-based medicine, it is customary to believe that a patient with GCS ≤ 8 should be intubated to avoid aspiration, or aspiration pneumonia/pneumonitis, and consequently, reduce mortality. Does the coma's state etiology have a word on this?  Read more in D. Orso et al. study.

WHAT'S PRIMARILY TO CARE IN PATIENTS TRAPPED IN MOTOR VEHICLE COLLISIONS?

Prolonged entrapment and/or intrusion into a vehicle after a collision is considered high risk for significant injury. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation .....but which types and in what rate other time-critical injuries occur?
T. Nutbeam et al. analysed data from 63,625 injured patients to help guide meaningful patient-focused interventions and future extrication strategies.

PoCUS INCREASES APPROPRIATE TREATMENT ADMINISTRATION IN PATIENTS WITH RESPIRATORY FAILURE

Patients admitted with acute signs of respiratory failure are a challenge for emergency physicians. Point-of-care ultrasound (PoCUS) is a focus oriented tool for differentiating among cardiopulmonary diseases. M. Riishede et al. demonstrate how PoCUS in combination with standard clinical examination increases the proportion of patients, who receive appropriate treatment within 4 h from admission and spend less than 1 day in hospital.

EARLY ASSESSMENT OF FRAILTY CONDITIONS IN OLDER PEOPLE: STILL A CHALLENGE?

In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on outcomes and that early identification can guide frailty specific care. Frailty is a condition characterised by a cumulative decline of physiological resilience across several body systems. The ageing population is increasing and so is the prevalence of frailty, with estimates ranging from 4.0–59.1%. 
Heather Jarman et al. in this study evaluate the feasibility of nurse-led assessment of frailty in older trauma patients admitted to major trauma centres.

CHALLENGES IN MOUNTAIN RESCUE

Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority and time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Read the Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom) for physicians and other advanced life support personnel.

EUROPEAN PARAMEDIC CURRICULUM - A CALL FOR UNITY

The education and training of paramedics greatly varies within European countries. Some require a BS degree, while others have shorter coursework at a lower academic level. The growing need for highly educated paramedics should be addressed by offering a bachelor’s degree university education with an exemplary curriculum and coordinating it within Europe. An European Paramedic Curriculum (EPaCur) and an attractive educational training programme could potentially raise the level of competency of paramedic practitioners and the potential for longer and wider career options. 
Read more in this Commentary from S. Dúason et al.

HEMS DISPATCH SENSITIVITY IN OLDER TRAUMA PATIENTS

Helicopter Emergency Medical Services (HEMS) respond to serious trauma and medical emergencies. Geographical disparity and the regionalisation of trauma systems can complicate accurate HEMS dispatch.
J.E. Griggs et al., in this study, evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in 1321 trauma patients aged ≥65 that were attended by the Air Ambulance Kent Surrey Sussex over a 6-year period.

CARDIOPULMONARY RESUSCITATION: INTRAOSSEOUS OR INTRAVENOUS VASCULAR ACCESS?

Emergency airway management both in the emergency department and in the pre-hospital phase of care is not only a key intervention but also a cause of much controversy and uncertainty. Rapid sequence induction (RSI) is the method that we use to try to achieve definitive airway control effectively and rapidly. The original descriptions of RSI delivered great In US, there are more than 300,000 out-of-hospital cardiac arrests (OHCA) every year, and the survival rate at hospital discharge is around 10%. Resuscitation guidelines suggest epinephrine should be timely administered since each minute from arrival of emergency medical services  to epinephrine administration is associated with a 4% decrease in odds of survival. Although intravenous administration is typically recommended, establishing IV access is not always fast or practical and an alternative route may be preferable. 
Yu-Lin Hsieh et al., in this study, advise on best practices.

PROS & CONS OF SMARTPHONE-BASED ACTIVATION OF COMMUNITY FIRST RESPONDERS FOR OUT OF HOSPITAL CARDIAC ARREST

A Community First Responder (CFR) is a local volunteer who agrees to undertake training in Basic Life Support. Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. C. Metelmann et al. review the current state of SBA of CFR in five European countries, reveal pros & cons, and presents consensus statements to support public decision making on future strategies.

REBOA: WHERE ARE WE & WHERE DO WE GO?

The role of the Resuscitative Endovascular Occlusion of the Aorta (REBOA) has been recently rediscovered and many trauma centres and some pre-hospital services are considering whether endovascular resuscitation should have a place in their services. M.A. Thrailkill et al. from the Uniformed Services University of the Health Sciences in Bethesda give a comprehensive and balanced description of the techniques, the evidence to date and where the immediate future is likely to take us.

The top five research priorities in physician-provided pre-hospital critical care

HAVE A LOOK AT THE MONTHLY MOST MENTIONED ARTICLES