Asunto(s)
Acetaminofén/uso terapéutico , Analgésicos no Narcóticos/uso terapéutico , Sepsis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Puntuaciones en la Disfunción de Órganos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/mortalidad , Análisis de SupervivenciaRESUMEN
Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a 'can't intubate, can't oxygenate' scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population. Electronic callipers were used to measure the maximum height of the cricothyroid membrane on 482 reformatted trauma computed tomography scans, 377 (78.2%) of which were in male patients. The mean (SD) height of the cricothyroid membrane, as independently measured by two radiologists, was 7.89 (2.21) mm and 7.88 (2.22) mm in male patients, and 6.00 (1.76) mm and 5.92 (1.71) mm in female patients. The presence of concurrent tracheal intubation or cervical spine immobilisation was found not to have a significant effect on cricothyroid membrane height. The cricothyroid membrane height in the study population was much smaller than that previously reported. Practitioners encountering patients who may require an emergency surgical airway should be aware of these data. Rescue airway equipment with variety of external diameters should be immediately available.
Asunto(s)
Cartílago Cricoides/anatomía & histología , Intubación Intratraqueal/métodos , Tomografía Computarizada por Rayos X/métodos , Heridas y Lesiones/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cartílago Cricoides/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Heridas y Lesiones/diagnóstico por imagen , Adulto JovenRESUMEN
Prehospital staff have made a significant contribution in recent years to improving care for patients with acute coronary syndrome, multiple trauma and stroke. There is, however, another group of patients that is not currently being targeted, with a similar time-critical condition. This group of patients is those with severe sepsis and septic shock and they could also benefit greatly from timely prehospital care. This article will consider how prehospital staff can improve the outcome of patients with severe sepsis, and in particular how they can aid emergency departments in identifying and initiating treatment in patients with severe sepsis.
Asunto(s)
Servicios Médicos de Urgencia/métodos , Sepsis/terapia , Antibacterianos/uso terapéutico , Comunicación , Enfermedad Crítica , Tratamiento de Urgencia/métodos , Fluidoterapia/métodos , Humanos , Ácido Láctico/metabolismo , Oxígeno/uso terapéuticoRESUMEN
Scoring systems for both trauma and intensive care patients have been widely used since the 1960's. This article will introduce several scoring systems currently in use and discuss their potential use for military ICU patients.