77 research outputs found
What is the best way to keep the patient warm during technical rescue? Results from two prospective randomised controlled studies with healthy volunteers
No full textAbstract Background Accidental hypothermia is a manifest problem during the rescue of entrapped victims and results in different subsequent problems as coagulopathy and wound infection. Different warming methods are available for the preclinicial use. However, their effectiveness has hardly been evaluated. Methods In a first step a survey among German fire brigades was performed with questions about the most used warming methods. In a second step two crossover studies were conducted. In each study two different warming method were compared with forced air warming – which is the most frequently used and highly effective warming method in operation rooms (Study A: halogen floodlight vs. forced air warming; Study B: forced air warming vs. fleece blanket). In both studies healthy volunteers (Study A: 30 volunteers, Study B: 32 volunteers) were sitting 60 min in a cold store. In the first 21 min there was no subject warming. Afterwards the different warming methods were initiated. Every 3 min parameters like skin temperature, core body temperature and cold perception on a 10-point numeric rating scale were recorded. Linear mixed models were fitted for each parameter to check for differences in temperature trajectories and cold perception with regard to the different warming methods. Results One hundred fifty-one German fire brigades responded to the survey. The most frequently used warming methods were different rescue blankets (gold/silver, wool) and work light (halogen floodlights). Both studies (A and B) showed significantly (p < 0.05) higher values in mean skin temperature, mean body temperature and total body heat for the forced air warming methods compared to halogen floodlight respectively fleece blanket shortly after warming initiation. In contrast, values for the cold perception were significantly lower (less unpleasant cold perception) during the phase the forced air warming methods were used, compared to the fleece blanket or the halogen floodlight was used. Conclusion Forced air warming methods used under the standardised experimental setting are an effective method to keep patients warm during technical rescue. Halogen floodlight has an insufficient effect on the patient’s heat preservation. In healthy subjects, fleece blankets will stop heat loss but will not correct heat that has already been lost. Trial registration The studies were registered retrospectively on 14/02/2022 on the German Clinical Trials registry (DRKS) with the number DRKS00028079
The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine
No full textBackground: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. Methods: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) >= 16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. Results: The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. Discussion: HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. Conclusions: The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption
Der Aufstieg von Erde und Menschheit kosmische Schlüssel für dein Leben in der fünften Dimension
No full textAmmoniakproductie volgens ICI patent EP 0 212 889
No full textDocument(en) uit de collectie Chemische ProcestechnologieDelftChemtechApplied Science
Musik und Film : Hilfsmittel, Lexika, Verzeichnisse
No full textInhalt: 1. Bibliographien 2. Musikographien, Diskographien, Filmographien 3. Biographica, Werkverzeichnisse, Personenlexik
Kulturelles Kapital und Spannungsschema – Pluralisierung für die oberen Schichten oder Egalisierung von Reproduktionswegen?
No full textProspective study of the efficacy of thermo-productive procedures under preclinical conditions - a volunteer simulation
No full textHypotherme Zustände in Zusammenhang mit unfallbedingten schweren Verletzungen sind häufig und haben weitreichende Folgen auf die Hämostase und Immunologie (Tsuei und Kearney 2004). Die Maßnahmen, die akzidentelle Hypothermie zu bekämpfen oder ihre Entstehung zu verhindern, müssen daher möglichst früh, also in der prä-hospitalen Phase begonnen werden. Maßnahmen, die aktuell in der Präklinik an Unfallstellen zur Anwendung kommen, sind jedoch zum überwiegenden Teil passive Wärmemethoden, wie Decken o.ä. Die im innerklinischen Bereich für die Wärmung von Patienten etablierten konvektiven Luftwärmer kommen bisher frühestens in der Schockraumphase zur Anwendung. Für die Frage, ob die Wärmung mittels Decken oder konvektiven Luftwärmern im präklinischen Bereich unter deutlich niedrigeren Umgebungstemperaturen funktioniert, gibt es bisher nur eine Studie. Diese wurde jedoch mit Geräten durchgeführt, welche aufgrund der abgegebenen Temperaturen für den Einsatz am Patienten nicht sicher geeignet sind (Jebens 2014). Diese Frage und ob das eine Verfahren dem anderen in der Effektivität der Erwärmung überlegen ist, sollte mit dieser Studie beantwortet werden. Hierzu durchliefen 32 gesunde Probanden randomisiert an unterschiedlichen Tagen mit einer Pause von mindestens 24h zwei Versuchsreihen. Sie wurden jeweils für 21 Minuten bekleidet mit Unterwäsche, T-Shirt, Shorts und Socken bei einer Umgebungstemperatur von 3 °C auf einem Stuhl platziert. Nach Ablauf dieser Zeit wurden sie entweder für weitere 39 Minuten mit einer Vlies-Einmaldecke, wie sie standardisiert bei Einsätzen von Feuerwehren und Rettungsdiensten zur Anwendung kommt, gewärmt oder ein konvektiver Luftwärmer, wie er im innerklinischen Bereich standardisiert verwendet wird, wurde mit einer entsprechenden Wärmedecke für die weiteren 39 Minuten eingesetzt. Als Messwerte wurden dreiminütlich neben den Vitalparametern Blutdruck, Herzfrequenz und periphere Sauerstoffsättigung die Körpertemperatur mittels tympanaler Temperaturmessung und vier weiterer Hauttemperaturmesspunkte ermittelt. In der statistischen Auswertung konnte gezeigt werden, dass der konvektive Luftwärmer deutlich effektiver ist als der Einsatz der Vlies-Einmaldecke. Beide Verfahren können hierbei sicher unter präklinischen Bedingungen zum Einsatz kommen. Als Ergebnis dieser Arbeit ist der Einsatz von konvektiven Luftwärmern bereits in der prä-hospitalen Phase an der Unfallstelle zu fordern und zu etablieren. Auch sollte das Rettungsdienstpersonal gerade bei schwer verletzten Patienten noch mehr auf ein effektives Temperaturmanagement achten und zumindest sollte eine Vlies-Einmaldecke oder etwas ähnliches Verwendung finden, um einem weiteren Wärmeverlust vorzubeugen. Die Überwachung der Körpertemperatur muss zum Standardmonitoring gehören. Hypothermic conditions associated with accidental serious injury are common and have far-reaching implications for hemostasis and immunology (Tsuei and Kearney 2004). Measures to combat or prevent accidental hypothermia must therefore be started as early as possible, i.e. in the pre-hospital phase. However, measures that are currently used at the accident site in the pre-clinic are predominantly passive heat methods, such as blankets or the like. The convective air warmers established in the hospital area for the warming of patients have so far been used at the earliest in the trauma room phase.
For the question, whether the warming by means of blankets or convective air warmers in the preclinical area works under clearly lower ambient temperatures, there is so far only one study. However, this was done with devices that are unsuitable for use on patients due to the temperatures released (Jebens 2014). This question and whether one method is superior to the other in the effectiveness of warming should be answered with this study.
For this purpose, 32 healthy volunteers (probands) underwent randomized trials on different days with a break of at least 24 h. They were each placed on a chair for 21 minutes wearing their underwear, T-shirt, shorts and socks at an ambient temperature of 3 ° C. At the end of this time, they were either warmed for an additional 39 minutes with a fleece disposable blanket, as is standard for use by fire departments and rescue services, or a convective air heater as used in the in-hospital area, was provided with a corresponding thermal blanket for the additional 39 minutes.
In addition to the vital parameters of blood pressure, heart rate and peripheral oxygen saturation, the body temperature was determined three minutes apart by tympanic temperature measurement and four other skin temperature measuring points. The statistical analysis showed that the convective air heater is significantly more effective than the use of the disposable fleece blanket. Both procedures can certainly be used under preclinical conditions. As a result of this work, the use of convective air warmers in the pre-hospital phase at the scene of the accident has to be demanded and established. Also, the rescue service personnel should pay even more attention to an effective temperature management, especially in severely injured patients and at least should use a disposable fleece blanket or something similar, to prevent further heat loss. The monitoring of body temperature must be part of the standard monitoring.2018-05-1
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