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Prehospital blood component therapy poses a possible treatment option among patients with severe bleeding. The aim of this paper was to characterize patients receiving prehospital blood component therapy by a paramedic-doctor-staffed, ground-based prehospital critical care (PHCC) service.
Bleeding patients with a clinical need for prehospital blood transfusion were included prospectively. The following data were collected: indication for transfusion, mechanism of injury, vital parameters, units of red blood cells (RBCs)/plasma transfused, degree of shock, demographics, and mortality.
Twenty-one patients received blood products: 12 (57%) traumatic injuries and nine (43%) non-traumatic bleeds, with a median of 1.5 (range 1.0-2.0) units of RBCs and 1.0 (range 0.0-2.0) unit of plasma. The most frequent trigger to initiate transfusion was on-going excessive bleeding and hypotension. Improved systolic blood pressure (SBP) and milder degrees of shock were observed after transfusion. Mean time from initiation of transfusion to hospital arrival was 24 minutes. In-hospital, 11 patients (61%) received further transfusion and 13 (72%) had urgent surgery within 24 hours. Overall, 28-day mortality was 29% at 24-hours and 33% at 28-days.
Prehospital blood component therapy is feasible in a ground-based prehospital service in a medium-sized Scandinavian city. Following transfusion, patient physiology and degree of shock were significantly improved.
Pre-hospital airway management is an essential skill for every pre-hospital clinician and should be performed to the same standards as would be expected in the emergency department. This chapter recommends tailored pre-hospital airway management in terms of clinical care delivered to the patient, skills of the clinician and the infrastructure of emergency medical system to achieve this. The importance of having a standardised, well-rehearsed approach, using aids to reduce cognitive load, articulating a clear airway management plan and having a structured way of handling airway management difficulties is highlighted. The concept of the physiologically difficult airway is discussed and the significance of excellent pre-oxygenation, peroxygenation, first-pass success and post-intubation care is discussed. Backup equipment in the form of second generation supraglottic airway devices, a videolaryngoscope with both standard and hyperangulated blades and equipment for an emergency front of neck airway should be available when advanced pre-hospital airway management is provided. When delivering airway management to trauma patients, an awareness of potential anatomical difficulties combined with careful management of physiological derangement is necessary to deliver safe, high quality care.
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