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Level I Trauma Center (level + i_trauma_center)

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Medical Sciences	100%

Selected Abstracts

Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients

ACADEMIC EMERGENCY MEDICINE, Issue 12 2004
Larry Brannam MD
Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source]

Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 3 2004
Paul A. Silka MD
Abstract Objective: To determine the efficacy of pain scores in improving pain management practices for trauma patients in the emergency department (ED). Methods: A prospective, observational study of analgesic administration to trauma patients was conducted over a nine-week period following educational intervention and introduction of verbal pain scores (VPSs). All ED nursing and physician staff in an urban Level I trauma center were trained to use the 0,10 VPS. Patients younger than 12 years old, having a Glasgow Coma Scale score (GCS) <8, or requiring intubation were excluded from analysis. Demographics, mechanism of injury, vital signs, pain scores, and analgesic data were extracted from a computerized ED database and patients' records. The staff was blinded to the ongoing study. Results: There were 150 patients studied (183 consecutive trauma patients seen; 33 patients excluded per criteria). Pain scores were documented for 73% of the patients. Overall, 53% (95% confidence interval [CI] = 45% to 61%) of the patients received analgesics in the ED. Of the patients who had pain scores documented, 60% (95% CI = 51% to 69%) received analgesics, whereas 33% (95% CI = 18% to 47%) of the patients without pain scores received analgesics. No patient with a VPS < 4 received analgesics, whereas 72% of patients with a VPS > 4 and 82% with a VPS > 7 received analgesics. Mean time to analgesic administration was 68 minutes (95% CI = 49 to 87). Conclusions: Pain assessment using VPS increased the likelihood of analgesic administration to trauma patients with higher pain scores in the ED. [source]

Utility of an Initial D-dimer Assay in Screening for Traumatic or Spontaneous Intracranial Hemorrhage

ACADEMIC EMERGENCY MEDICINE, Issue 9 2001
Mark E. Hoffmann MD
Abstract Objective: To evaluate the sensitivity of a D-dimer assay as a screening tool for possible traumatic or spontaneous intracranial hemorrhage. If adequately sensitive, the D-dimer assay may potentially permit omission of a more expensive computed tomography (CT) scan of the head when such hemorrhage is clinically suspected. Methods: Prospective, consecutive, blinded study of patients (age > 16 years) requiring a CT scan of the head for suspected intracranial hemorrhage over a five-month period at a university, Level I trauma center. All study patients had a serum D-dimer assay obtained prior to their CT scans. Sensitivity and specificity, with 95% confidence intervals (95% CIs), of the enzyme-linked immunosorbent assay (ELISA) D-dimer assay for the detection of intracranial hemorrhage were calculated. Results: Of the 319 patients entered in the study, 25 (7.8%) had a CT scan positive for intracranial hemorrhage. Patients with intracranial hemorrhage were more likely to have a positive D-dimer assay (chi-square ? 13.075, p < 0.001). The D-dimer assay had 21 true-positive and four false-negative tests, resulting in a sensitivity of 84.0% (95% CI ? 63.7% to 95.5%) and a specificity of 55.8% (95% CI ? 55.5% to 55.9%). The four false-negative cases included one small intraparenchymal hemorrhage, one small subarachnoid hemorrhage, one moderate-sized intraparenchymal hemorrhage with mid-line shift, and one large subdural hematoma requiring emergent surgery. Conclusions: Due to the catastrophic nature of missing an intracranial hemorrhage in the emergency department, the D-dimer assay is not adequately sensitive or predictive to use as a screening tool to allow routine omission of head CT scanning. [source]

Patterns of Maxillofacial Injuries As a Function of Automobile Restraint Use,

THE LARYNGOSCOPE, Issue 4 2000
M. Scott Major MD
Abstract Objective To determine the pattern and severity of maxillofacial injuries sustained in a motor vehicle accident (MVA) resulting from automobile restraint use. Design Retrospective database review of patients injured in a MVA who were admitted to the level I trauma center at the University of Louisville Hospital in Louisville, Kentucky. Methods Demographic data, drug and alcohol impairment screening, and comorbidity data were obtained from database searches of trauma records. Forty-four patients had an airbag deployed, 34 patients wore seat belts, and 94 patients were unrestrained. All maxillofacial Abbreviated Injury Scale (AIS) ratings were compared among the three groups. Results Twenty-two of the 44 patients (50%) in the airbag group sustained only facial injuries. Fifteen of them had lacerations; four others had only facial abrasions. Three of the airbag patients had moderate facial injuries (AIS = 2); none required operative management. The airbag group had a mean AIS rating of 1.13, the seat belt group a mean AIS of 1.29, and the unrestrained group a mean AIS of 1.46. Patients using either seat belts (mean age, 40.5 y) or airbags (mean age, 44.9 y) were older than the unrestrained group (mean age, 39.6 y). Drug and/or alcohol impairment was significantly greater in the unrestrained group (mean, 38%) compared with the seat belt group (mean, 26%) and the airbag group (mean 11%). Conclusions Use of airbags is associated with less severe maxillofacial injuries compared with either a seat belt alone or no restraint. There is an inherent risk of minor maxillofacial injuries with airbag usage, but the severity of injury is distinctly reduced. [source]