Browsing by Subject "Intubation"

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  • Saviluoto, Anssi; Harve-Rytsälä, Heini; Lääperi, Mitja; Kirves, Hetti; Jantti, Helena; Nurmi, Jouni (2020)
    Background Identifying stroke and other intracranial lesions in patients with a decreased level of consciousness may be challenging in prehospital settings. Our objective was to investigate whether the combination of systolic blood pressure, heart rate and age could be used to identify intracranial lesions. Methods We conducted a retrospective case-control study including patients with a decreased level of consciousness who had their airway secured during prehospital care. Patients with intracranial lesions were identified based on the final diagnoses at the end of hospitalization. We investigated the ability of systolic blood pressure, heart rate and age to identify intracranial lesions and derived a decision instrument. Results Of 425 patients, 127 had an intracranial lesion. Patients with a lesion were characterized by higher systolic blood pressure, lower heart rate and higher age (P <0.0001 for all). A systolic blood pressure >= 140 mmHg had an odds ratio (OR) of 3.5 (95% confidence interval [CI] 1.7 to 7.0), and > 170 mmHg had an OR of 8.2 (95% CI 4.5-15.32) for an intracranial lesion (reference: <140 mmHg). A heart rate <100 beats/min had an OR of 3.4 (95% CI 2.0 to 6.0, reference: >= 100). Age 50-70 had an OR of 4.1 (95% CI 2.0 to 9.0), and > 70 years had an OR of 10.2 (95% CI 4.8 to 23.2), reference: <50. Logarithms of ORs were rounded to the nearest integer to create a score with 0-2 points for age and blood pressure and 0-1 for heart rate, with an increasing risk for an intracranial lesion with higher scores. The area under the receiver operating characteristics curve for the instrument was 0.810 (95% CI 0.850-0.890). Conclusions An instrument combining systolic blood pressure, heart rate and age may help identify stroke and other intracranial lesions in patients with a decreased level of consciousness in prehospital settings.
  • Sunde, Geir Arne; Heltne, Jon-Kenneth; Lockey, David; Burns, Brian; Sandberg, Marten; Fredriksen, Knut; Hufthammer, Karl Ove; Soti, Akos; Lyon, Richard; Jantti, Helena; Kamarainen, Antti; Reid, Bjorn Ole; Silfvast, Tom; Harm, Falko; Sollid, Stephen J. M.; Airport Study Grp (2015)
    Background: Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. Methods: We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. Results: The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p <0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Conclusions: Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.
  • Pitkänen, Mikko; Kontio, Risto; Förster, Johannes (2018)
    Lähtökohdat Hammasvaurio on yleinen anestesiaan, intubaatioon ja elvytykseen liittyvä haittatapahtuma. Menetelmät Analyysi perustuu Potilasvakuutuskeskuksessa v. 2000–13 loppuun käsiteltyihin vahinkoilmoituksiin. Tulokset Hammasvaurioita anestesian ja intubaation yhteydessä koski 137 vahinkoilmoitusta. Potilaille oli tehty leikkaus (83 %), intubaatio hätätilanteessa (7 %) tai muu toimenpide (mm. kardioversio). Tapauksista 66 % liittyi laryngoskopiaan ja intubaatioon ja vajaa 20 % nielutuubin tai kurkunpäänaamarin käyttöön.Vaikea intubaatio oli riskitekijä. Terve hammas vaurioitui 7 %:ssa. Vaurio korvattiin neljälle potilaalle (2,9 %). Päätelmät Hammasvahingolle altistavat heikentynyt hampaisto ja intubaatio. Oikeusturvan takia on tärkeää kirjata hammasstatus etukäteen. Potilasvakuutuskeskus korvaa anestesian aikaisen hammasvaurion harvoin. Nopea hoito voi pelastaa vaurioituneen hampaan.
  • Suominen, Janne; Salminen, Päivi; Usvasalo, Anu; Nokso-Koivisto, Johanna (2018)
    Trakeostomia eli henkitorviavanteen teko on lapsella hengitystieongelmien hoidon äärimuoto. Sen tarve on harkittava tarkasti huomioiden lapsen sairaudet, kokonaistilanne ja mahdollisuus hoitoon ¬yksikössä, jossa hoidosta on tarpeeksi kokemusta. Toimenpiteen yleisimpiä syitä ovat kasvojen rakennepoikkeavuudet, hengitysteiden ahtaumat ja keuhkoputken vaikea pehmeys. Kotiin pyritään järjestämään hoitorinki ympärivuorokautisen hoidon varmistamiseksi.
  • Sepponen, Roope; Saviluoto, Anssi; Jäntti, Helena; Harve-Rytsälä, Heini; Lääperi, Mitja; Nurmi, Jouni (2022)
    Objectives: Recognizing stroke and other intracranial pathologies in prehospital phase facilitates prompt recanalization and other specific care. Recognizing these can be difficult in patients with decreased level of consciousness. We previously derived a scoring system combining systolic blood pressure, age and heart rate to recognize patients with intracranial pathology. In this study we aimed to validate the score in a larger, separate population. Materials and methods: We conducted a register based retrospective study on patients >= 16 years old and Glasgow Coma Score