Pre-hospital Care: The Trapped Patient

Mackenzie, R; Sutcliffe, RC

doi:10.1136/jramc-146-01-09

Cited by 10 publications

(20 citation statements)

References 27 publications

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“…The IV route provides more effective and predictable sedation than the IM route and should be used unless the casualty is trapped with no IV access (64,70). An initial dose of 2mg/kg produces deep sedation within 30 seconds for 5 to 10 minutes.…”

Section: Ketaminementioning

confidence: 99%

“…Recovery is indicated by nystagmus, vocalization and movements in response to stimulation (as opposed to purposeless movements). This initial profound sedation may allow painful procedures to be carried out including extrication from entrapment (64,70), and manipulation of fractures. Facilities for airway management must be available although use of ketamine in this way (as opposed to prolonged procedures under general anaesthesia) has few risks in published series (71).…”

Section: Ketaminementioning

confidence: 99%

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Analgesia and sedation

Mackenzie¹

2000

J R Army Med Corps

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Section: Ketaminementioning

confidence: 99%

Section: Ketaminementioning

confidence: 99%

Analgesia and sedation

Mackenzie¹

2000

J R Army Med Corps

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“…Many advocate this level of monitoring in pre-hospital care, particularly in the context of entrapment and pre-hospital anaesthesia (24). Pocked sized pulse oximeter, capnometry or combined units are now available and should certainly be considered in the trauma bag if anaesthesia is contemplated.…”

Section: Chest Injuries and Ventilatory Supportmentioning

confidence: 99%

“…Perhaps the most appropriate fluid replacement for casualties who are trapped at the scene and shocked is blood. Blood transfusion is indicated when the estimated blood loss is > 20% blood volume and the expected duration of entrapment and transfer is likely to exceed the time required to organise blood (24). It may take a long time to organise blood at the scene if arrangements have not been made in advance with receiving medical facilities.…”

Section: Bleeding and Circulatory Supportmentioning

confidence: 99%

Equipment for Immediate Medical Care

2000

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The equipment lists provided in this article are not intended to be proscriptive or definitive. They are simply an illustration of the logical application of equipment selection and packing principles according to the likely needs of the casualty. Although trained personnel with relatively little equipment can perform simple interventions, optimal care requires some advanced techniques and good quality comprehensive equipment. Such equipment is available for pre-hospital use. Regardless of what equipment is packed, the immediate care practitioner must understand the circumstances in which the equipment is likely to be used and tailor it to the likely needs of the casualty.

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“…While this standard of care is entirely appropriate in many circumstances, it is recognised that some patients may be inappropriately immobilised and that this may result in delays (both at the scene and in the receiving facility) as well as discomfort for the patient (3). Rescue from entrapment may be much quicker if, in appropriate circumstances, full spinal precautions can be safely avoided ( Figure 1) (4). Similarly, delayed or prolonged evacuation from remote or operational environments may make spinal immobilisation, particularly if using improvised equipment, impossible to achieve and potentially harmful to the patient and rescuers ( Figure 2) (5-7).…”

Section: Introductionmentioning

confidence: 99%

Spinal Injuries

Mackenzie¹

2002

J R Army Med Corps

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The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disruption. Early ventilation and differentiation of haemorrhagic from neurogenic shock are the key elements of pre-hospital resuscitation specific to spinal injuries. Falls from a significant height, high-impact speed road accidents, blast injuries, direct blunt or penetrating injuries near the spine and other high energy injuries should all be regarded as high risk for spinal injury but clinical examination should determine whether the patient requires full, limited or no spinal immobilisation. Although there is little conclusive evidence in the literature that supports pre-hospital clinical clearance of the spine, the similarities between pre-hospital immobilisation decisions and in-hospital radiography decisions are such that it is likely that clinical clearance will be effective for selected patients. This decision can be made at the scene provided the patient has no evidence of: Altered level of consciousness or mental status Intoxication Neurological symptoms or signs A distracting painful injury (e.g. chest injuries, long bone fracture) Midline spinal pain or tenderness. Where there is evidence to support spinal immobilisation, then the full range of devices and techniques should be considered. In the remote or operational environment where pre-hospital times are prolonged, full immobilisation, analgesia and re-assessment may allow localisation of the injury and a reduction in the degree of immobilisation. Common reasons for missing significant spinal injuries include failing to consider the possibility of spinal injuries in patients who are either unconscious, intoxicated or uncooperative (54,55). The application of the decision rule discussed here will ensure that no clinically significant spinal injuries are missed in pre-hospital care.

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Pre-hospital Care: The Trapped Patient

Cited by 10 publications

References 27 publications

Analgesia and sedation

Analgesia and sedation

Equipment for Immediate Medical Care

Spinal Injuries

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